scholarly journals Clinical application and utility of genomic assays in early-stage breast cancer: key lessons learned to date

2018 ◽  
Vol 25 ◽  
pp. 125 ◽  
Author(s):  
S.K.L. Chia
Keyword(s):  
Breast Cancer ◽  
Health Care Providers ◽  
Hormone Receptor ◽  
Early Stage ◽  
Prospective Trial ◽  
Lessons Learned ◽  
Her2 Status ◽  
Care Providers ◽  
Screening Programs ◽  
Genomic Assays

Early-stage hormone receptor–positive breast cancer is the most common subtype and stage presenting in countries with organized screening programs. Standard clinical and pathologic factors are routinely used to support prognosis and decisions about adjuvant therapies. Hormone receptor and her2 status are essential for decision-making about the use of adjuvant hormonal and anti-her2 therapies respectively. Genomic assays are now commercially available to aid in either further prognostication or in refining the potential benefit of adjuvant chemotherapy. The current genomic assays all generally quantify estrogen receptor and proliferation gene sets (among others) by rna expression, although the specific genes assayed are quite discordant. The present review focuses on the pivotal studies in which each assay attempted to demonstrate clinical utility, with an emphasis on prospective trial data for each assay, if available. Using genomic assays, health care providers will increasingly be able to individualize therapy or de-escalate therapy, optimizing clinic benefit while minimizing toxicities from systemic therapies.

scholarly journals FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU IBU RUMAH TANGGA MELAKUKAN PEMERIKSAAN PAYUDARA SENDIRI (SADARI)

2018 ◽  
Vol 12 (2) ◽  
pp. 143
Author(s):  
Alvita Brilliana R. Arafah ◽  
Hari Basuki Notobroto
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Care Providers ◽  
Early Stage ◽  
Health Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Information Accessibility ◽  
Breast Examination ◽  
Access Information

Breast cancer is cancer with the number of new cases and deaths highest in Indonesia. According to the Data Center and Information Ministry of a health Indonesia in the year 2013, the number of new cases of breast cancer of 819 and the number of deaths amounted to 217. In general, breast cancer known after stepping on an advanced stage. So the methods of early detection of breast cancer are focused on the detection of early stage tumors that are usually small with self-breast examination (SADARI). The purpose of this research is to predict the factors related to the behavior of self-breast examination (SADARI) the housewives aged 40–50 years. This research is an observational study with cross sectional approach. Sample research totaling 100 people  housewife in Kelurahan Sidotopo Wetan Kenjeran Subdistrict Surabaya. The measurement was done by providing a questionnaire to obtain information about the research variables. Variable independent research is k nowledge, attitudes, information accessibility, support health providers and descent with breast cancer. The results of this research showed the variables that are associated with the  SADARI behavior of the housewifes is attitude (p = 0.000), accessibility of information (p = 0.000), and health care providers support (p = 0.010). The majority of housewives in Kelurahan Sidotopo Wetan Kenjeran Sub-district Surabaya showed a good attitude and support toward SADARI. In the area surrounding the residence h ousewife get access information easily. There are no support for doing SADARI from health care providers.

Compliance and arthralgias in clinical therapy (COMPACT): Assessment of the incidence of arthralgia, therapy costs, and compliance in the first year of adjuvant anastrozole.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11040-e11040
Author(s):  
Peyman Hadji ◽  
Maria Blettner ◽  
Wolfgang W. Bolten ◽  
Nadia Harbeck ◽  
Hans-Joachim Hindenburg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care Providers ◽  
Prospective Trial ◽  
Treatment Compliance ◽  
Treatment Costs ◽  
Endocrine Treatment ◽  
First Year ◽  
Care Providers ◽  
Real World Data ◽  
Therapy Costs

e11040^ Background: Aromatase Inhibitors (AI) are well established as adjuvant endocrine treatment for postmenopausal women with HR+ early breast cancer (EBC). However, clinical trial data show higher frequently of arthralgia with AI than tamoxifen. As arthralgia may be greatly influencing compliance to adjuvant therapy, we designed a prospective trial to collect real world data on the effects of AI-associated arthralgia on patient compliance, patient outcomes and treatment costs of arthralgia. Methods: COMPACT is an open, prospective non-interventional study (NCT00857012) assessing the incidence of arthralgia, therapy costs, and compliance within the first year of adjuvant anastrozole (ANA) therapy in postmenopausal patients with HR+ EBC. Patients on adjuvant ANA for 3-6 months were enrolled and stratified by initial adjuvant ANA or switch from tamoxifen. All patients receive regular standardized information about breast cancer from baseline to week 20 to support treatment compliance. Data on demographics, arthralgia, therapy thereof and QoL are collected at baseline, 3, 6 and 9 months. Primary endpoints are scaled data on arthralgia and compliance within the first year of ANA therapy. Secondary endpoints include the incidence of arthralgia, therapy costs, reasons for non-compliance, and influence of arthralgia on clinical outcome. Results: From Apr 2009 to Mar 2011, 2313 patients were enrolled, 2007 on upfront ANA and 306 patients on switch therapy. The mean age was 64.5 years, mean BMI 27.7. Only 16.8% had received HRT prior to their EBC. 41.5% had symptoms relating to skeleton or musculature, and 11.9% stated arthralgia existing prior to ANA. 13.1% reported a worsening of pre-existing arthralgias or new arthralgia after starting ANA. Predictors for non-adherence to AI and scaled data on arthralgia are under analysis. Conclusions: COMPACT aims to provide valid data on AI-associated arthralgia, treatment, treatment costs and compliance to AI. This may help to better inform patients and health care providers about these clinically important issues with the aim to improve adherence to adjuvant ANA, breast cancer outcomes, and therapy costs.

scholarly journals Promoting Clinical Breast Evaluations in a Lower Middle–Income Country Setting: An Approach Toward Achieving a Sustainable Breast Health Program

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Roziya Buribekova ◽  
Irina Shukurbekova ◽  
Surayo Ilnazarova ◽  
Nekruz Jamshevov ◽  
Guldarbogh Sadonshoeva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Family Medicine ◽  
Early Detection ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Early Stage ◽  
Health Board ◽  
Care Providers ◽  
Clinical Breast

Purpose To promote a systems-based approach for the early detection and downstaging of breast cancer at presentation in the remote mountainous region of Gorno Badakhshan Autonomous Oblast (GBAO), Tajikistan, by introducing breast cancer awareness into the community and training health care professionals in clinical breast evaluation (CBE). Methods Through a public-private partnership between the Ministry of Health, the Aga Khan Health Services, Tajikistan, and the Aga Khan Health Board, we organized breast cancer screening in the community and trained family medicine doctors (FMDs) and family medicine nurses (FMNs) in CBE. We identified and trained CBE master trainers, who, in turn, systematically trained FMNs to conduct CBEs in each of the remote regional clinics. Results Between 2014 and 2017, 47 FMDs (85% of all FMDs in GBAO), 166 FMNs (55% of all FMNs in GBAO), and six master trainers were trained. Of 3,556 women who were screened, abnormal CBEs were noted in 696 of them (20%). Of the last 1,101 CBEs that were performed by trainee FMNs, with secondary CBEs by master trainers, the rate of abnormal CBEs plateaued at 9%. A total of 18 women were diagnosed with breast cancer—2.6% of abnormal CBEs and 0.5% of all screened women. Conclusion A dual-pronged approach of community awareness and CBE training of health care professionals, supported by CBE master trainers, offers a sustainable approach for the early detection of breast pathology. We observed anecdotal evidence of clinical early-stage detection over time with improved CBE proficiency and community acceptance. Sustaining this program will require advocacy by health care providers and a responsive public policy to support the early detection and treatment of breast cancer across the region.

scholarly journals Evaluation of a Breast Cancer Early Detection Curriculum Among Nurses Working in 5 Antiretroviral Clinics in Eswatini

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 14-14
Author(s):  
Daniel S. O’Neil ◽  
Sifiso Nxumalo ◽  
Cebisile Ngcamphalala ◽  
Judith S. Jacobson ◽  
Harriet Nuwagaba-Biribonwoha ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care Providers ◽  
Clinical Skills ◽  
Early Stage ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Maximum Score ◽  
Cancer Early Detection ◽  
Sub Saharan

PURPOSE Breast cancer (BC) incidence is rising in sub-Saharan Africa, and approximately 75% of cases are diagnosed at stages III and IV. Women living with HIV, who are surviving longer with antiretroviral use, are also increasingly affected. Survey data suggest that primary care providers often fail to recognize early-stage BC. We trained nurses from 5 antiretroviral clinics in Eswatini to assess breast abnormalities and evaluated our curriculum’s effectiveness in improving BC knowledge and skills. METHODS The 2-day curriculum covered breast physiology, benign pathology, and BC. Clinical breast exam and management were taught using mannequins and standardized patient scenarios, with emphasis on prompt referral for biopsy. After training, mentoring was provided every 2 to 4 weeks at each study clinic. A written examination of BC knowledge (maximum score, 23 points) and an observed examination of practical clinical skills (maximum score, 28 points) were administered before training, immediately after training, and 90 days after training. Pre- and post-training scores were compared using Wilcoxon signed-rank tests. RESULTS Forty-four nurses, with a median of 10 years of experience, underwent training; only 5 nurses (11%) reported prior BC education. All nurses completed the pre- and immediate post-training exams, and 38 completed the 90-day post-training exams. Median scores on pre-, immediate post-, and 90-day post-training knowledge exams were 17.5 (interquartile range [IQR], 16-19), 20 (IQR, 19-21), and 20 (IQR, 19-21), respectively. Median scores on pre-, immediate post-, and 90-day post-training practical exams were 10 (IQR, 7-11), 23 (IQR, 21.5-25), and 23 (IQR, 22-24), respectively. Compared with pretraining scores, immediate post- and 90-day post-training scores on both exams were significantly improved ( P < .0001 for all comparisons). CONCLUSION Our curriculum produced a sustained improvement in nurses’ BC-related knowledge and clinical skills, including identification of possible early cancers. Our results resemble those among similarly trained Rwandan nurses, suggesting that the curriculum may generally benefit front-line health care providers and patients in sub-Saharan Africa.

Patient and provider education on HER2-positive metastatic breast cancer: Defining gaps in clinician practice, patient behaviors, patient-provider alignment, and clinical knowledge.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23007-e23007
Author(s):  
Wendy Turell ◽  
Tariqa Ackbarali
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Metastatic Breast ◽  
Lessons Learned ◽  
Care Providers ◽  
Provider Education ◽  
Her2 Positive ◽  
Cancer Management

e23007 Background: Current breast cancer management is driven by inherent heterogeneity of disease. Therapeutic options for later lines of HER2 therapy have expanded, shifting practice patterns to incorporate the latest evidence and guidelines. Health care providers (HCPs) require education to synthesize new evidence in the context of clinical practice including three approved HER2-directed therapies between December 2019 and April 2020. Concurrent patient and caregiver education is imperative to improve collaborative treatment decisions for HER2+ metastatic breast cancer (MBC). Methods: Two, 1-hour online video-based programs were hosted in June, 2020 for HCPs and patients/caregivers, respectively. Practice and knowledge gaps among HCPs, and knowledge, communication and self-efficacy behaviors among patients were assessed. Each activity was interactive, consisting of slides, polling and live questions, and both remain on-demand (and on social media for patients/caregivers) for 12 months. Assessments were administered at 3 time points (pre-, immediate post-, and 2 mos. post-activity). Data from these questions, responses to live polling questions, and learner-submitted questions during live Q&A were analyzed to determine engagement, lessons learned, and continuing education gaps. Results: As of February 2021, 525 HCPs and 9,582 patients (9,449 Facebook Video; 133 CancerCoachLive.com) participated in the ongoing activities. Post education, HCP learners anticipated the education would positively impact practice behavior (77%) and patient clinical outcomes (73%). HCP improvements in pre/post knowledge and competence questions were realized in 3/4 of the questions. Of patients/caregivers, 34% more learners reported confidence in managing their condition post vs. pre-education. They listed “affording therapy” and “understanding treatment options” as their greatest challenges, and reported “self-care strategies” as their most sought information during the COVID-19 pandemic. At 2-mos. follow-up, 83% of patients reported improvements in communication with their HCPs, and 77% of HCPs reported improvements in their clinical practice. Updated data will be shared, including aligned HCP and patient questions pertaining to care challenges and communication goals. Conclusions: CME and patient education can yield gains in clinical practice behaviors, patient healthcare communication and confidence, and treatment knowledge of HER2-postive breast cancer. Together, aligned education directed to HCPs and patients can improve the ability to provide evidence-based treatment for patients.

Medical Informatics and the Quality of Health: New Approaches to Support Patient Care

2003 ◽  
Vol 42 (02) ◽  
pp. 185-189 ◽  
Author(s):  
R. Haux ◽  
C. Kulikowski ◽  
A. Bohne ◽  
R. Brandner ◽  
B. Brigl ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Health Care Providers ◽  
Medical Knowledge ◽  
Lessons Learned ◽  
Care Providers ◽  
Access To Health Services ◽  
Leading Role ◽  
Future Challenges

Summary Objectives: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (www.yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. Results and Conclusions: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

scholarly journals Loco-regional recurrence trend and prognosis in young women with breast cancer according to molecular subtypes: analysis of 1099 cases

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yang Li ◽  
Su Lu ◽  
Yuhan Zhang ◽  
Shuaibing Wang ◽  
Hong Liu
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Molecular Subtypes ◽  
Early Stage ◽  
Young Patients ◽  
Distant Metastases ◽  
Early Stage Breast Cancer ◽  
Regional Recurrence ◽  
Her2 Status ◽  
Over Time

Abstract Background The number of young patients diagnosed with breast cancer is on the rise. We studied the rate trend of local recurrence (LR) and regional recurrence (RR) in young breast cancer (YBC) patients and outcomes among these patients based on molecular subtypes. Methods A retrospective cohort study was conducted based on data from Tianjin Medical University Cancer Institute and Hospital for patients ≤ 35 years of age with pathologically confirmed primary invasive breast cancer surgically treated between 2006 and 2014. Patients were categorized according to molecular subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year rates for LR, RR, and distant metastases (DM) were estimated by Kaplan-Meir statistics. Nelson-Aalen cumulative-hazard plots were used to describe local recurrence- and distant metastasis-free intervals. Results We identified 25,284 patients with a median follow-up of 82 months, of whom 1099 (4.3%) were YBC patients ≤ 35 years of age. The overall 5-year LR, RR, and DM rates in YBC patients were 6.7%, 5.1%, and 16.6%, respectively. The LR and RR rates demonstrated a decreasing trend over time (P = 0.028 and P = 0.015, respectively). We found that early-stage breast cancer and less lymph node metastases increased over time (P = 0.004 and P = 0.007, respectively). Patients with HR−/HER2+ status had a significantly higher LR (HR 20.4; 95% CI, 11.8–35.4) and DM (HR 37.2; 95% CI, 24.6–56.3) at 10 years. Breast-conserving surgery (BCS) or mastectomy did not influence rates of LR and RR. In the overall population, the 5-year survival of YBC patients exceeded 90%. Conclusions The rates of LR and RR with YBC patients demonstrated a downward trend and the proportion of early-stage breast cancer increased between 2006 and 2014. We report the highest LR rates in this young population were associated with HR−/HER2+ tumors.

Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy

2007 ◽  
Vol 17 (5) ◽  
pp. 1104-1112 ◽  
Author(s):  
S. Tangjitgamol ◽  
S. Manusirivithaya ◽  
J. Hanprasertpong ◽  
P. Kasemsarn ◽  
T. Soonthornthum ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Sexual Dysfunction ◽  
Sexual Function ◽  
Sexual Intercourse ◽  
Health Care Providers ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Care Providers ◽  
Public Media ◽  
Early Stage Cervical Cancer

We determined the prevalence of sexual dysfunction in women with early-stage cervical cancer who had undergone radical hysterectomy in three institutions of Thailand. An interview was conducted according to the structured questionnaire composing of seven domains of sexual function: frequency, desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia. From 105 women included in the study, mean age was 45.3 ± 7.8 years. Seventy-five (71.4%) were in premenopausal period. Eight out of 105 women (7.6%) never resumed their sexual intercourse after radical hysterectomy, 97 women resumed their sexual intercourse during 1–36 months postoperation (median, 4 months). Dyspareunia was increased in approximately 37% of women, while the other six domains of sexual function were decreased, ranging from approximately 40–60%. Of interest, only 10.5% of these cervical cancer women had some information of sexual function from medical or paramedical personnel, 17.1% obtained it from other laymen or public media, and 61.9% had never had it from any resources. Our conclusion is—sexual dysfunction is a common problem after cervical cancer treatment, but it has not been well aware of. These findings may necessitate health care providers to be more considerate on this problem.

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