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Kimmick, Gretchen Genevieve

Overview:

Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.

Positions:

Associate Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1989

M.D. — Wake Forest University

M.S. 2000

M.S. — Wake Forest University

Medical Resident, Medicine

University of Florida

Fellow In Oncology, Medicine

North Carolina Baptist Hospital

News:

Grants:

Improving Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
July 01, 2016
End Date
June 30, 2021

Optimizing Delivery of a Behavioral Cancer Pain Intervention Using a SMART

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Clinical Associate
Start Date
June 01, 2016
End Date
May 31, 2021

A Self-Management Intervention for Women with Breast Cancer and Diabetes

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
American Cancer Society, Inc.
Role
Co Investigator
Start Date
July 01, 2016
End Date
June 30, 2020

A novel strategy to see and treat breast cancer: translation to intra-operative breast margin assessment

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 15, 2017
End Date
July 31, 2019

Harnessing the power of light to see and treat breast cancer

Administered By
Biomedical Engineering
AwardedBy
United States Army Medical Research and Materiel Command
Role
Investigator
Start Date
September 18, 2009
End Date
September 17, 2015

Improving Adherence to Recommended Surveillance in Breast Cancer Survivors

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 01, 2010
End Date
August 31, 2015

Daughters And MothErS (DAMES) Against Breast Cancer

Administered By
School of Nursing
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
June 10, 2007
End Date
May 31, 2010
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Publications:

Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance).

Breast cancer patients aged 65+ ("older") vary in frailty status. We tested whether a deficits accumulation frailty index predicted long-term mortality.Older patients (n = 1280) with non-metastatic, invasive breast cancer were recruited from 78 Alliance sites from 2004 to 2011, with follow-up to 2015. Frailty categories (robust, pre-frail, and frail) were based on 35 baseline illness and function items. Cox proportional hazards and competing risk models were used to calculate all-cause and breast cancer-specific mortality for up to 7 years, respectively. Potential covariates included demographic, psychosocial, and clinical factors, diagnosis year, and care setting.Patients were 65-91 years old. Most (76.6%) were robust; 18.3% were pre-frail, and 5.1% frail. Robust patients tended to receive more chemotherapy ± hormonal therapy (vs. hormonal) than pre-frail or frail patients (45% vs. 37 and 36%, p = 0.06), and had the highest adherence to hormonal therapy. The adjusted hazard ratios for all-cause mortality (n = 209 deaths) were 1.7 (95% CI 1.2-2.4) and 2.4 (95% CI 1.5-4.0) for pre-frail and frail versus robust women, respectively, with an absolute mortality difference of 23.5%. The adjusted hazard of breast cancer death (n-99) was 3.1 (95% CI 1.6-5.8) times higher for frail versus robust patients (absolute difference of 14%). Treatment differences did not account for the relationships between frailty and mortality.Most older breast cancer patients are robust and could consider chemotherapy where otherwise indicated. Patients who are frail or pre-frail have elevated long-term all-cause and breast cancer mortality. Frailty indices could be useful for treatment decision-making and care planning with older patients.

Authors
Mandelblatt, JS; Cai, L; Luta, G; Kimmick, G; Clapp, J; Isaacs, C; Pitcher, B; Barry, W; Winer, E; Sugarman, S; Hudis, C; Muss, H; Cohen, HJ; Hurria, A
MLA Citation
Mandelblatt, JS, Cai, L, Luta, G, Kimmick, G, Clapp, J, Isaacs, C, Pitcher, B, Barry, W, Winer, E, Sugarman, S, Hudis, C, Muss, H, Cohen, HJ, and Hurria, A. "Frailty and long-term mortality of older breast cancer patients: CALGB 369901 (Alliance)." Breast cancer research and treatment 164.1 (July 2017): 107-117.
PMID
28364214
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
164
Issue
1
Publish Date
2017
Start Page
107
End Page
117
DOI
10.1007/s10549-017-4222-8

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).

Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods.Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25).ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.

Authors
Kimmick, GG; Major, B; Clapp, J; Sloan, J; Pitcher, B; Ballman, K; Barginear, M; Freedman, RA; Artz, A; Klepin, HD; Lafky, JM; Hopkins, J; Winer, E; Hudis, C; Muss, H; Cohen, H; Jatoi, A; Hurria, A; Mandelblatt, J
MLA Citation
Kimmick, GG, Major, B, Clapp, J, Sloan, J, Pitcher, B, Ballman, K, Barginear, M, Freedman, RA, Artz, A, Klepin, HD, Lafky, JM, Hopkins, J, Winer, E, Hudis, C, Muss, H, Cohen, H, Jatoi, A, Hurria, A, and Mandelblatt, J. "Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)." Breast cancer research and treatment 163.2 (June 2017): 391-398.
PMID
28283904
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
163
Issue
2
Publish Date
2017
Start Page
391
End Page
398
DOI
10.1007/s10549-017-4188-6

Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART.

Pain is common in cancer patients and results in lower quality of life, depression, poor physical functioning, financial difficulty, and decreased survival time. Behavioral pain interventions are effective and nonpharmacologic. Traditional randomized controlled trials (RCT) test interventions of fixed time and dose, which poorly represent successive treatment decisions in clinical practice. We utilize a novel approach to conduct a RCT, the sequential multiple assignment randomized trial (SMART) design, to provide comparative evidence of: 1) response to differing initial doses of a pain coping skills training (PCST) intervention and 2) intervention dose sequences adjusted based on patient response. We also examine: 3) participant characteristics moderating intervention responses and 4) cost-effectiveness and practicality.Breast cancer patients (N=327) having pain (ratings≥5) are recruited and randomly assigned to: 1) PCST-Full or 2) PCST-Brief. PCST-Full consists of 5 PCST sessions. PCST-Brief consists of one 60-min PCST session. Five weeks post-randomization, participants re-rate their pain and are re-randomized, based on intervention response, to receive additional PCST sessions, maintenance calls, or no further intervention. Participants complete measures of pain intensity, interference and catastrophizing.Novel RCT designs may provide information that can be used to optimize behavioral pain interventions to be adaptive, better meet patients' needs, reduce barriers, and match with clinical practice. This is one of the first trials to use a novel design to evaluate symptom management in cancer patients and in chronic illness; if successful, it could serve as a model for future work with a wide range of chronic illnesses.

Authors
Kelleher, SA; Dorfman, CS; Plumb Vilardaga, JC; Majestic, C; Winger, J; Gandhi, V; Nunez, C; Van Denburg, A; Shelby, RA; Reed, SD; Murphy, S; Davidian, M; Laber, EB; Kimmick, GG; Westbrook, KW; Abernethy, AP; Somers, TJ
MLA Citation
Kelleher, SA, Dorfman, CS, Plumb Vilardaga, JC, Majestic, C, Winger, J, Gandhi, V, Nunez, C, Van Denburg, A, Shelby, RA, Reed, SD, Murphy, S, Davidian, M, Laber, EB, Kimmick, GG, Westbrook, KW, Abernethy, AP, and Somers, TJ. "Optimizing delivery of a behavioral pain intervention in cancer patients using a sequential multiple assignment randomized trial SMART." Contemporary clinical trials 57 (June 2017): 51-57.
PMID
28408335
Source
epmc
Published In
Contemporary Clinical Trials
Volume
57
Publish Date
2017
Start Page
51
End Page
57
DOI
10.1016/j.cct.2017.04.001

Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance).

To determine long-term quality-of-life (QOL) trajectories among breast cancer survivors aged 65+ (older) evaluating the effects of personality and social support.Older women (N = 1280) newly examined with invasive, nonmetastatic breast cancer completed baseline assessments. Follow-up data were collected 6 and 12 months later and then annually for up to 7 years (median 4.5 years). Quality of life was assessed using EORTC-QLQ-C30 emotional, physical, and cognitive scales. Optimism (Life Orientation Test), Coping (Brief COPE), and social support (Medical Outcomes Study) were assessed at baseline. Group-based trajectory modeling identified QOL trajectories; multinomial regression evaluated effects of predictors on trajectory groups. Age, education, systemic therapy, comorbidity, and reported precancer function (SF-12) were considered as controlling variables.Three trajectories were identified for each QOL domain: "maintained high," "phase shift" (lower but parallel scores to "maintained high" group), and "accelerated decline" (lowest baseline scores and steepest decline). Accelerated decline in emotional, physical, and cognitive function was seen in 6.9%, 31.8%, and 7.6% of older survivors, respectively. Maladaptive coping and lower social support increased adjusted odds of being in the accelerated decline group for all QOL domains; lower optimism was only related to decline in emotional function. Chemotherapy was related to physical and cognitive but not emotional function trajectories.Personality and social resources affect the course of long-term emotional well-being of older breast cancer survivors; treatment is more important for physical and cognitive than emotional function. Early identification of those vulnerable to deterioration could facilitate clinical and psychological support.

Authors
Durá-Ferrandis, E; Mandelblatt, JS; Clapp, J; Luta, G; Luta, G; Faul, L; Kimmick, G; Cohen, HJ; Yung, RL; Hurria, A
MLA Citation
Durá-Ferrandis, E, Mandelblatt, JS, Clapp, J, Luta, G, Luta, G, Faul, L, Kimmick, G, Cohen, HJ, Yung, RL, and Hurria, A. "Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance)." Psycho-oncology (February 20, 2017).
PMID
28219113
Source
epmc
Published In
Psycho-Oncology
Publish Date
2017
DOI
10.1002/pon.4404

Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527.

Purpose Despite increasing awareness of accrual challenges, it is unknown if accrual of older patients to breast cancer treatment trials is improving. Methods We examined accrual of older patients to Alliance for Clinical Trials in Oncology systemic therapy breast cancer trials during 1985-2012 and compared disease characteristics and reasons for therapy cessation for older (age ≥ 65 years and ≥ 70 years) versus younger (age < 65 years and < 70 years) participants. To examine accrual trends, we modeled age as a function of time, using logistic regression. Results Overall, 17% of study participants were ≥ 65 years of age. Approximately 15%, 24%, and 24% of participants in adjuvant, neoadjuvant, and metastatic trials were age ≥ 65 years, and 7%, 15%, and 13% were age ≥ 70 years, respectively. The odds of a patient age ≥ 65 years enrolling significantly increased over time for adjuvant trials (odds ratio [OR] per year, 1.04; 95% CI, 1.04 to 1.05) but decreased significantly for neoadjuvant and metastatic trials (OR, 0.62; 95% CI, 0.58 to 0.67 and OR, 0.98, 95% CI, 0.97 to 1.00). Similar trends were seen for those age ≥ 70 years but these were statistically significant for adjuvant and neoadjuvant trials only (OR, 1.05, 95% CI, 1.04 to 1.07; and OR, 0.57, 95% CI, 0.52 to 0.62). In general, those age ≥ 65 years ( v those < 65 years) in adjuvant studies had a higher mean number of lymph nodes involved and more hormone receptor-negative tumors, although tumor sizes were similar. Early protocol treatment cessation was also more frequent in those age ≥ 65 years (50%) versus < 65 years (35.9%) across trials. Conclusion Older patients with breast cancer remain largely underrepresented in cooperative group therapeutic trials. We observed some improvement in accrual to adjuvant trials but worsening of accrual for neoadjuvant/metastatic trials. Novel strategies to increase accrual of older patients are critical to meaningfully change the evidence base for this growing patient population.

Authors
Freedman, RA; Foster, JC; Seisler, DK; Lafky, JM; Muss, HB; Cohen, HJ; Mandelblatt, J; Winer, EP; Hudis, CA; Partridge, AH; Carey, LA; Cirrincione, C; Moreno-Aspitia, A; Kimmick, G; Jatoi, A; Hurria, A
MLA Citation
Freedman, RA, Foster, JC, Seisler, DK, Lafky, JM, Muss, HB, Cohen, HJ, Mandelblatt, J, Winer, EP, Hudis, CA, Partridge, AH, Carey, LA, Cirrincione, C, Moreno-Aspitia, A, Kimmick, G, Jatoi, A, and Hurria, A. "Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 35.4 (February 2017): 421-431.
PMID
27992272
Source
epmc
Published In
Journal of Clinical Oncology
Volume
35
Issue
4
Publish Date
2017
Start Page
421
End Page
431
DOI
10.1200/jco.2016.69.4182

Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511).

We examined acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) events among 9679 women treated for breast cancer on four adjuvant Alliance for Clinical Trials in Oncology trials with >90 months of follow-up in order to better characterize the risk for AML/MDS in older patients receiving anthracyclines.We used multivariable Cox regression to examine factors associated with AML/MDS, adjusting for age (≥65 vs. <65 years; separately for ≥70 vs. <70 years), race/ethnicity, insurance, performance status, and anthracycline receipt. We also examined the effect of cyclophosphamide, the interaction of anthracycline and age, and outcomes for those developing AML/MDS.On Cancer and Leukemia Group B (CALGB) 40101, 49907, 9344, and 9741, 7290 received anthracyclines; 15% were in the age ≥65 and 7% were ≥70. Overall, 47 patients developed AML/MDS (30 AML [0.3%], 17 MDS [0.2%]); 83% of events occurred within 5 years of study registration. Among those age ≥65 and ≥70, 0.8 and 1.0% developed AML/MDS (vs. 0.4% for age <65), respectively. In adjusted analyses, older age and anthracycline receipt were significantly associated with AML/MDS (adjusted hazard ratio [HR] for age ≥65 [vs. <65] = 3.13, 95% confidence interval [CI] 1.18-8.33; HR for anthracycline receipt [vs. no anthracycline] = 5.16, 95% CI 1.47-18.19). There was no interaction between age and anthracycline use. Deaths occurred in 70% of those developing AML/MDS.We observed an increased risk for AML/MDS for older patients and those receiving anthracyclines, though these events were rare. Our results help inform discussions surrounding anticipated toxicities of adjuvant chemotherapy in older patients.

Authors
Freedman, RA; Seisler, DK; Foster, JC; Sloan, JA; Lafky, JM; Kimmick, GG; Hurria, A; Cohen, HJ; Winer, EP; Hudis, CA; Partridge, AH; Carey, LA; Jatoi, A; Klepin, HD; Citron, M; Berry, DA; Shulman, LN; Buzdar, AU; Suman, VJ; Muss, HB
MLA Citation
Freedman, RA, Seisler, DK, Foster, JC, Sloan, JA, Lafky, JM, Kimmick, GG, Hurria, A, Cohen, HJ, Winer, EP, Hudis, CA, Partridge, AH, Carey, LA, Jatoi, A, Klepin, HD, Citron, M, Berry, DA, Shulman, LN, Buzdar, AU, Suman, VJ, and Muss, HB. "Risk of acute myeloid leukemia and myelodysplastic syndrome among older women receiving anthracycline-based adjuvant chemotherapy for breast cancer on Modern Cooperative Group Trials (Alliance A151511)." Breast cancer research and treatment 161.2 (January 2017): 363-373.
PMID
27866278
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
161
Issue
2
Publish Date
2017
Start Page
363
End Page
373
DOI
10.1007/s10549-016-4051-1

Chemotherapy-related cognitive impairment in older patients with cancer.

Chemotherapy-related cognitive impairment (CRCI) can occur during or after chemotherapy and represents a concern for many patients with cancer. Among older patients with cancer, in whom there is little clinical trial evidence examining side effects like CRCI, many unanswered questions remain regarding risk for and resulting adverse outcomes from CRCI. Given the rising incidence of cancer with age, CRCI is of particular concern for older patients with cancer who receive treatment. Therefore, research related to CRCI in older patients with cancers is a high priority. In this manuscript, we discuss current gaps in research highlighting the lack of clinical studies of CRCI in older adults, the complex mechanisms of CRCI, and the challenges in measuring cognitive impairment in older patients with cancer. Although we focus on CRCI, we also discuss cognitive impairment related to cancer itself and other treatment modalities. We highlight several research priorities to improve the study of CRCI in older patients with cancer.

Authors
Loh, KP; Janelsins, MC; Mohile, SG; Holmes, HM; Hsu, T; Inouye, SK; Karuturi, MS; Kimmick, GG; Lichtman, SM; Magnuson, A; Whitehead, MI; Wong, ML; Ahles, TA
MLA Citation
Loh, KP, Janelsins, MC, Mohile, SG, Holmes, HM, Hsu, T, Inouye, SK, Karuturi, MS, Kimmick, GG, Lichtman, SM, Magnuson, A, Whitehead, MI, Wong, ML, and Ahles, TA. "Chemotherapy-related cognitive impairment in older patients with cancer." Journal of geriatric oncology 7.4 (July 2016): 270-280. (Review)
PMID
27197918
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
4
Publish Date
2016
Start Page
270
End Page
280
DOI
10.1016/j.jgo.2016.04.008

Understanding cognition in older patients with cancer.

Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps.

Authors
Karuturi, M; Wong, ML; Hsu, T; Kimmick, GG; Lichtman, SM; Holmes, HM; Inouye, SK; Dale, W; Loh, KP; Whitehead, MI; Magnuson, A; Hurria, A; Janelsins, MC; Mohile, S
MLA Citation
Karuturi, M, Wong, ML, Hsu, T, Kimmick, GG, Lichtman, SM, Holmes, HM, Inouye, SK, Dale, W, Loh, KP, Whitehead, MI, Magnuson, A, Hurria, A, Janelsins, MC, and Mohile, S. "Understanding cognition in older patients with cancer." Journal of geriatric oncology 7.4 (July 2016): 258-269. (Review)
PMID
27282296
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
7
Issue
4
Publish Date
2016
Start Page
258
End Page
269
DOI
10.1016/j.jgo.2016.04.004

Clinical trial accrual in older cancer patients: The most important steps are the first ones

Authors
Kimmick, G
MLA Citation
Kimmick, G. "Clinical trial accrual in older cancer patients: The most important steps are the first ones." Journal of Geriatric Oncology 7.3 (May 2016): 158-161.
Source
crossref
Published In
Journal of Geriatric Oncology
Volume
7
Issue
3
Publish Date
2016
Start Page
158
End Page
161
DOI
10.1016/j.jgo.2016.03.006

What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors.

Multiple studies have yielded important findings regarding the determinants of an advanced-stage diagnosis of breast cancer. We seek to advance this line of inquiry through a broadened conceptual framework and accompanying statistical modeling strategy that recognize the dual importance of access-to-care and biologic factors on stage.The Centers for Disease Control and Prevention-sponsored Breast and Prostate Cancer Data Quality and Patterns of Care Study yielded a seven-state, cancer registry-derived population-based sample of 9,142 women diagnosed with a first primary in situ or invasive breast cancer in 2004. The likelihood of advanced-stage cancer (American Joint Committee on Cancer IIIB, IIIC, or IV) was investigated through multivariable regression modeling, with base-case analyses using the method of instrumental variables (IV) to detect and correct for possible selection bias. The robustness of base-case findings was examined through extensive sensitivity analyses.Advanced-stage disease was negatively associated with detection by mammography (P < 0.001) and with age < 50 (P < 0.001), and positively related to black race (P = 0.07), not being privately insured [Medicaid (P = 0.01), Medicare (P = 0.04), uninsured (P = 0.07)], being single (P = 0.06), body mass index > 40 (P = 0.001), a HER2 type tumor (P < 0.001), and tumor grade not well differentiated (P < 0.001). This IV model detected and adjusted for significant selection effects associated with method of detection (P = 0.02). Sensitivity analyses generally supported these base-case results.Through our comprehensive modeling strategy and sensitivity analyses, we provide new estimates of the magnitude and robustness of the determinants of advanced-stage breast cancer.Statistical approaches frequently used to address observational data biases in treatment-outcome studies can be applied similarly in analyses of the determinants of stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 25(4); 613-23. ©2016 AACR.

Authors
Lipscomb, J; Fleming, ST; Trentham-Dietz, A; Kimmick, G; Wu, X-C; Morris, CR; Zhang, K; Smith, RA; Anderson, RT; Sabatino, SA; Centers for Disease Control and Prevention National Program of Cancer Registries Patterns of Care Study Group,
MLA Citation
Lipscomb, J, Fleming, ST, Trentham-Dietz, A, Kimmick, G, Wu, X-C, Morris, CR, Zhang, K, Smith, RA, Anderson, RT, Sabatino, SA, and Centers for Disease Control and Prevention National Program of Cancer Registries Patterns of Care Study Group, . "What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors." Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 25.4 (April 2016): 613-623.
PMID
26819266
Source
epmc
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
25
Issue
4
Publish Date
2016
Start Page
613
End Page
623
DOI
10.1158/1055-9965.epi-15-0225

Impact of comorbidity on cancer screening and diagnosis

© Springer Science+Business Media Singapore 2016. The presence of coexistent chronic disease or comorbid illness has been shown to have an impact on the pathogenesis of cancer and on the frequency of screening, the stage at diagnosis, the intensity of treatment, and, therefore, on cancer outcomes. This chapter will focus on how comorbid illness affects cancer screening and diagnosis. There is some disagreement in the literature regarding how the comorbidity burden affects the screening and stage of cancer, particularly when specific comorbidities and the overall burden of comorbidity, measured by some aggregate index, are examined. Moreover, the extent of the relationship between comorbidity and cancer may be affected by the method by which the comorbidity burden is measured, with regard to breadth (number of comorbidities) and depth (severity of comorbidities). We consider some of these factors in this chapter as we examine the literature in view of four hypotheses: (1) The surveillance hypothesis, which suggests that patients with comorbid illnesses are screened more regularly or are more likely to be diagnosed earlier because they have more frequent contact with the medical care system. (2) The competing demand hypothesis, which posits that patients with comorbidities are screened less or diagnosed later because other chronic conditions represent a competing demand upon physician time and focus. (3) The physiological hypothesis, which argues that comorbid illness actually affects the pathogenesis, progression, and/or severity of cancer. (4) The death from other causes hypothesis, which suggests that patients or their physicians choose not to screen, because of the risk of death from a cause of other than cancer.

Authors
Fleming, ST; Sarfati, D; Kimmick, G; Schoenberg, N; Cunningham, R
MLA Citation
Fleming, ST, Sarfati, D, Kimmick, G, Schoenberg, N, and Cunningham, R. "Impact of comorbidity on cancer screening and diagnosis." Cancer and Chronic Conditions: Addressing the Problem of Multimorbidity in Cancer Patients and Survivors. January 1, 2016. 105-129.
Source
scopus
Publish Date
2016
Start Page
105
End Page
129
DOI
10.1007/978-981-10-1844-2_4

A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain.

Psychosocial pain management interventions are efficacious for cancer pain but are underutilized. Recent advances in mobile health (mHealth) technologies provide new opportunities to decrease barriers to access psychosocial pain management interventions. The objective of this study was to gain information about the accessibility and efficacy of mobile pain coping skills training (mPCST) intervention delivered to cancer patients with pain compared to traditional in-person pain coping skills training intervention. This study randomly assigned participants (N = 30) to receive either mobile health pain coping skills training intervention delivered via Skype or traditional pain coping skills training delivered face-to-face (PCST-trad). This pilot trial suggests that mPCST is feasible, presents low burden to patients, may lead to high patient engagement, and appears to be acceptable to patients. Cancer patients with pain in the mPCST group reported decreases in pain severity and physical symptoms as well as increases in self-efficacy for pain management that were comparable to changes in the PCST-trad group (p's < 0.05). These findings suggest that mPCST, which is a highly accessible intervention, may provide benefits similar to an in-person intervention and shows promise for being feasible, acceptable, and engaging to cancer patients with pain.

Authors
Somers, TJ; Kelleher, SA; Westbrook, KW; Kimmick, GG; Shelby, RA; Abernethy, AP; Keefe, FJ
MLA Citation
Somers, TJ, Kelleher, SA, Westbrook, KW, Kimmick, GG, Shelby, RA, Abernethy, AP, and Keefe, FJ. "A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain." Pain research and treatment 2016 (January 2016): 2473629-.
PMID
27891252
Source
epmc
Published In
Pain Research and Treatment
Volume
2016
Publish Date
2016
Start Page
2473629

Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy.

To explore how symptoms and psychosocial factors are related to intentional and unintentional non-adherent medication taking behaviors.Included were postmenopausal women with hormone receptor positive, stage I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and were taking endocrine therapy. Self-administered, standardized measures were completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy for Appropriate Medication Use Scale. Regression analyses were performed to determine the degree to which demographic, medical, symptom, and psychosocial variables, explain intentional, such as changing one's doses or stopping medication, and unintentional, such as forgetting to take one's medication, non-adherent behaviors.Participants were 112 women: mean age 64 (SD = 9) years; 81% white; mean time from surgery 40 (SD = 28) months; 49% received chemotherapy (39% including a taxane); mean time on endocrine therapy, 35 (SD = 29.6) months; 82% taking an aromatase inhibitor. Intentional and unintentional non-adherent behaviors were described in 33.9% and 58.9% of participants, respectively. Multivariate analysis showed that higher self-efficacy for taking medication was associated with lower levels of unintentional (p = 0.002) and intentional (p = 0.004) non-adherent behaviors. The presence of symptoms (p = 0.03) and lower self-efficacy for physician communication (p = 0.009) were associated with higher levels of intentional non-adherent behaviors.These results suggest that women who report greater symptoms, lower self-efficacy for communicating with their physician, and lower self-efficacy for taking their medication are more likely to engage in both intentional and unintentional non-adherent behaviors.

Authors
Kimmick, G; Edmond, SN; Bosworth, HB; Peppercorn, J; Marcom, PK; Blackwell, K; Keefe, FJ; Shelby, RA
MLA Citation
Kimmick, G, Edmond, SN, Bosworth, HB, Peppercorn, J, Marcom, PK, Blackwell, K, Keefe, FJ, and Shelby, RA. "Medication taking behaviors among breast cancer patients on adjuvant endocrine therapy." Breast (Edinburgh, Scotland) 24.5 (October 2015): 630-636.
PMID
26189978
Source
epmc
Published In
The Breast
Volume
24
Issue
5
Publish Date
2015
Start Page
630
End Page
636
DOI
10.1016/j.breast.2015.06.010

CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers.

CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

Authors
Sutton, LM; Geradts, J; Hamilton, EP; Havlin, KA; Kimmick, GG; Marcom, PK; Spector, NL; Watson, M; Rabin, DU; Bruno, TO; Noe, A; Miller, S; Subramaniam, C; Layton, S; Grichnik, K
MLA Citation
Sutton, LM, Geradts, J, Hamilton, EP, Havlin, KA, Kimmick, GG, Marcom, PK, Spector, NL, Watson, M, Rabin, DU, Bruno, TO, Noe, A, Miller, S, Subramaniam, C, Layton, S, and Grichnik, K. "CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers." Journal of the National Comprehensive Cancer Network : JNCCN 13.8 (August 2015): 1005-1011.
PMID
26285246
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
8
Publish Date
2015
Start Page
1005
End Page
1011
DOI
10.6004/jnccn.2015.0121

Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income.

There are wide disparities in breast cancer-specific survival by patient sociodemographic characteristics. Women of lower income, for instance, have higher relapse and death rates from breast cancer. One possible contributing factor for this disparity is low use of adjuvant endocrine therapy-an extremely efficacious therapy in women with early stage, hormone receptor positive breast cancer, the most common subtype of breast cancer. Alone, adjuvant endocrine therapy decreases breast cancer recurrence by 50% and death by 30%. Data suggest that low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome in low-income breast cancer patients.

Authors
Ursem, CJ; Bosworth, HB; Shelby, RA; Hwang, W; Anderson, RT; Kimmick, GG
MLA Citation
Ursem, CJ, Bosworth, HB, Shelby, RA, Hwang, W, Anderson, RT, and Kimmick, GG. "Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income." Journal of women's health (2002) 24.5 (May 2015): 403-408. (Review)
PMID
25884292
Source
epmc
Published In
Journal of Women's Health
Volume
24
Issue
5
Publish Date
2015
Start Page
403
End Page
408
DOI
10.1089/jwh.2014.4982

Patterns of locoregional treatment for nonmetastatic breast cancer by patient and health system factors.

The purpose of this study was to examine local definitive therapy for nonmetastatic breast cancer with the Patterns of Care Breast and Prostate Cancer (POCBP) study of the National Program of Cancer Registries (Centers for Disease Control and Prevention).POCBP medical record data were re-abstracted in 7 state/regional registry systems (Georgia, North Carolina, Kentucky, Louisiana, Wisconsin, Minnesota, and California) to verify data quality and assess treatment patterns in the population. National Comprehensive Cancer Network clinical practice treatment guidelines were aligned with American Joint Committee on Cancer staging at diagnosis to appraise care.Six thousand five hundred five of 9142 patients with registry-confirmed breast cancer were coded as having primary disease with stage 0 to IIIA tumors and were included in the study. Approximately 88% received guideline-concordant locoregional treatment. However, this outcome varied by age group: 92% of women < age 50 versus 80% of women ≥ age 70 years old received guideline care (P < 0.01). Characteristics that best discriminated receipt (no/yes) of guideline-concordant care in receiver operating curve analyses were the receipt of breast-conserving surgery (BCS) versus mastectomy (C = 0.70), patient age (C = 0.62), a greater tumor stage (C = 0.60), public insurance (C = 0.58), and the presence of at least mild comorbidity (C = 0.55). Radiation therapy (RT) after BCS was the most omitted treatment component causing nonconcordance in the study population. In multivariate regression, the effects of the treatment facility, ductal carcinoma in situ, race, and comorbidity on nonconcordant care differed by age group.Patterns of underuse of standard therapies for breast cancer vary by age group and BCS use, with which there is a risk of omission of RT.

Authors
Anderson, RT; Morris, CR; Kimmick, G; Trentham-Dietz, A; Camacho, F; Wu, X-C; Sabatino, SA; Fleming, ST; Lipscomb, J
MLA Citation
Anderson, RT, Morris, CR, Kimmick, G, Trentham-Dietz, A, Camacho, F, Wu, X-C, Sabatino, SA, Fleming, ST, and Lipscomb, J. "Patterns of locoregional treatment for nonmetastatic breast cancer by patient and health system factors." Cancer 121.5 (March 2015): 790-799.
PMID
25369150
Source
epmc
Published In
Cancer
Volume
121
Issue
5
Publish Date
2015
Start Page
790
End Page
799
DOI
10.1002/cncr.29092

Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†.

Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools.SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use.Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim. In 11 direct comparisons for detecting problems on a full GA, the G8 was more or equally sensitive than other instruments in all six comparisons, whereas results were mixed for the VES-13 in seven comparisons. In addition, different tools have demonstrated associations with outcome measures, including G8 and VES-13.Screening tools do not replace GA but are recommended in a busy practice in order to identify those patients in need of full GA. If abnormal, screening should be followed by GA and guided multidisciplinary interventions. Several tools are available with different performance for various parameters (including sensitivity for addressing the need for further GA). Further research should focus on the ability of screening tools to build clinical pathways and to predict different outcome parameters.

Authors
Decoster, L; Van Puyvelde, K; Mohile, S; Wedding, U; Basso, U; Colloca, G; Rostoft, S; Overcash, J; Wildiers, H; Steer, C; Kimmick, G; Kanesvaran, R; Luciani, A; Terret, C; Hurria, A; Kenis, C; Audisio, R; Extermann, M
MLA Citation
Decoster, L, Van Puyvelde, K, Mohile, S, Wedding, U, Basso, U, Colloca, G, Rostoft, S, Overcash, J, Wildiers, H, Steer, C, Kimmick, G, Kanesvaran, R, Luciani, A, Terret, C, Hurria, A, Kenis, C, Audisio, R, and Extermann, M. "Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†." Annals of oncology : official journal of the European Society for Medical Oncology 26.2 (February 2015): 288-300.
PMID
24936581
Source
epmc
Published In
Annals of Oncology
Volume
26
Issue
2
Publish Date
2015
Start Page
288
End Page
300
DOI
10.1093/annonc/mdu210

Individual, Area, and Provider Characteristics Associated With Care Received for Stages I to III Breast Cancer in a Multistate Region of Appalachia.

We describe individual, area, and provider characteristics associated with care patterns for early-stage breast cancer in Appalachian counties of Kentucky, North Carolina, Ohio, and Pennsylvania.Cases of stages I to III breast cancer from 2006 to 2008 were linked to Medicare claims occurring within 1 year of diagnosis. Rates of guideline-concordant endocrine therapy (n = 1,429), chemotherapy (n = 1,480), and radiation therapy (RT) after breast-conserving surgery were studied; RT was studied in women age ≥ 70 years with stage I estrogen receptor (ER) -positive/progesterone receptor (PR) -positive cancer, for whom RT was optional (n = 1,108), and in all others, for whom RT was guideline concordant (n = 1,422). Univariable and multivariable analyses were performed. Independent variables included age, race, county-level economic status, state, surgeon graduation year and volume, comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, trastuzumab use, and surgery type.Population mean age was 74 years; 97% were white. For endocrine therapy, chemotherapy, and RT, guideline concordance was 76%, 48%, and 83%, respectively. Where it was optional, 77% received RT. Guideline-concordant endocrine therapy was lower in North Carolina versus Pennsylvania (odds ratio [OR], 0.60; 95% CI, 0.41 to 0.88) and higher if surgeon graduated between 1984 and 1988 versus ≥ 1989 (OR, 1.58; 95% CI, 1.06 to 2.34). Guideline-concordant chemotherapy varied significantly by state, county-level economic status, and surgeon volume. In guideline-concordant RT, lower surgeon volume (v highest) predicted RT use (OR, 1.63; 95% CI, 1.61 to 2.36). In optional RT, North Carolina residence (v Pennsylvania; OR, 0.29; 95% CI, 0.17 to 0.48) and counties with higher economic status (OR, 0.61; 95% CI, 0.40 to 0.94) predicated RT omission.Notable variation in care by geographic and surgical provider characteristics provides targets for further research in underserved areas.

Authors
Kimmick, GG; Camacho, F; Mackley, HB; Kern, T; Yao, N; Matthews, SA; Fleming, S; Lipscomb, J; Liao, J; Hwang, W; Anderson, RT
MLA Citation
Kimmick, GG, Camacho, F, Mackley, HB, Kern, T, Yao, N, Matthews, SA, Fleming, S, Lipscomb, J, Liao, J, Hwang, W, and Anderson, RT. "Individual, Area, and Provider Characteristics Associated With Care Received for Stages I to III Breast Cancer in a Multistate Region of Appalachia." Journal of oncology practice 11.1 (January 2015): e9-e18.
PMID
25228530
Source
epmc
Published In
Journal of Oncology Practice
Volume
11
Issue
1
Publish Date
2015
Start Page
e9
End Page
e18
DOI
10.1200/jop.2014.001397

A phase II study of medroxyprogesterone acetate in patients with hormone receptor negative metastatic breast cancer: translational breast cancer research consortium trial 007.

Preclinical data suggest that medroxyprogesterone acetate (MPA) has both anti-metastatic and anti-angiogenic activity in the absence of hormone receptors (HR). This phase II trial assessed the activity of MPA alone or in combination with low-dose chemotherapy in patients with metastatic HR-negative breast cancer. Postmenopausal women with HR-negative disease were eligible if they had not received more than 3 chemotherapy regimens for metastatic disease. All patients were treated with MPA 1,000-1,500 mg/day orally; patients in cohort two also received low-dose oral cyclophosphamide and methotrexate (ldCM, 50 mg/day and 2.5 mg twice daily on Days 1 and 2 each week). Tissue and circulating biomarkers were assessed serially. The primary endpoint was clinical benefit response defined as objective response or stable disease >6 months. Thirty patients were enrolled (14 MPA monotherapy; 16 MPA + ldCM); median age was 55 (35-80); nearly all had visceral involvement. Despite dose escalation in 90 % of patients, only 17 (57 %) patients ever achieved MPA trough concentrations >50 ng/ml. One patient developed grade 4 renal failure in the setting of rapid disease progression and dehydration. There were no objective responses. One patient in each cohort (~7 %) had stable disease for > 6 months. Skin Nm23 expression increased after 4 weeks of MPA + ldCM, but there were no significant changes in TSP-1, PAI-1 antigen, or PAI-1 activity. MPA had limited activity and does not warrant further development in patients with HR-negative advanced breast cancer. Poor bioavailability limited exposure despite dose escalation.

Authors
Miller, KD; Althouse, SK; Nabell, L; Rugo, H; Carey, L; Kimmick, G; Jones, DR; Merino, MJ; Steeg, PS
MLA Citation
Miller, KD, Althouse, SK, Nabell, L, Rugo, H, Carey, L, Kimmick, G, Jones, DR, Merino, MJ, and Steeg, PS. "A phase II study of medroxyprogesterone acetate in patients with hormone receptor negative metastatic breast cancer: translational breast cancer research consortium trial 007." Breast cancer research and treatment 148.1 (November 2014): 99-106.
PMID
25257727
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
148
Issue
1
Publish Date
2014
Start Page
99
End Page
106
DOI
10.1007/s10549-014-3131-3

Patient experience and attitudes toward addressing the cost of breast cancer care.

The American Society of Clinical Oncology views patient-physician discussion of costs as a component of high-quality care. Few data exist on patients' views regarding how cost should be addressed in the clinic.We distributed a self-administered, anonymous, paper survey to consecutive patients with breast cancer presenting for a routine visit within 5 years of diagnosis at an academic cancer center. Survey questions addressed experience and preferences concerning discussions of cost and views on cost control. Results are primarily descriptive, with comparison among participants on the basis of disease stage, using chi-square and Fisher's exact tests. All p values are two-sided.We surveyed 134 participants (response rate 86%). Median age was 61 years, and 28% had stage IV disease. Although 44% of participants reported at least a moderate level of financial distress, only 14% discussed costs with their doctor; 94% agreed doctors should talk to patients about costs of care. Regarding the impact of costs on decision making, 53% felt doctors should consider direct costs to the patient, but only 38% felt doctors should consider costs to society. Moreover, 88% reported concern about costs of care, but there was no consensus on how to control costs.Most breast cancer patients want to discuss costs of care, but there is little consensus on the desired content or goal of these discussions. Further research is needed to define the role of cost discussions at the bedside and how they will contribute to the goal of high-quality and sustainable cancer care.

Authors
Irwin, B; Kimmick, G; Altomare, I; Marcom, PK; Houck, K; Zafar, SY; Peppercorn, J
MLA Citation
Irwin, B, Kimmick, G, Altomare, I, Marcom, PK, Houck, K, Zafar, SY, and Peppercorn, J. "Patient experience and attitudes toward addressing the cost of breast cancer care." November 2014.
PMID
25273078
Source
epmc
Published In
The oncologist
Volume
19
Issue
11
Publish Date
2014
Start Page
1135
End Page
1140
DOI
10.1634/theoncologist.2014-0117

Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy.

This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer.One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years).Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p < 0.05). Self-efficacy for coping with symptoms moderated the relationship between physical symptoms and functional (B = 0.05, SE = 0.02, t = 2.67, p = 0.009) and emotional well-being (B = 0.03, SE = 0.01, t = 2.45, p = 0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being.Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.

Authors
Shelby, RA; Edmond, SN; Wren, AA; Keefe, FJ; Peppercorn, JM; Marcom, PK; Blackwell, KL; Kimmick, GG
MLA Citation
Shelby, RA, Edmond, SN, Wren, AA, Keefe, FJ, Peppercorn, JM, Marcom, PK, Blackwell, KL, and Kimmick, GG. "Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy." Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 22.10 (October 2014): 2851-2859.
PMID
24821365
Source
epmc
Published In
Supportive Care in Cancer
Volume
22
Issue
10
Publish Date
2014
Start Page
2851
End Page
2859
DOI
10.1007/s00520-014-2269-1

Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance).

We evaluated associations among comorbidity, toxicity, time to relapse (TTR), and overall survival (OS) in older women with early-stage breast cancer receiving adjuvant chemotherapy.Cancer and Leukemia Group B 49907 (Alliance) randomly assigned women ≥ 65 years old with stages I-III breast cancer to standard adjuvant chemotherapy or capecitabine. We reviewed data from 329 women who participated in the quality of life companion study CALGB 70103 and completed the Physical Health Subscale of the Older American Resources and Services Questionnaire. This questionnaire captures data on 14 comorbid conditions and the degree to which each interferes with daily activities. A comorbidity burden score was computed by multiplying the total number of conditions by each condition's level of interference with function. Outcomes were grade 3 to 5 toxicity, TTR, and OS. Logistic regression was used to evaluate associations between comorbidity and toxicity, and Cox proportional hazards models for TTR and survival.Number of comorbidities ranged from 0 to 10 (median 2); the comorbidity burden score ranged from 0 to 25 (median 3). The most common conditions were arthritis (58%) and hypertension (55%). Comorbidity was associated with shorter OS, but not with toxicity or TTR. The hazard of death increased by 18% for each comorbidity (hazard ratio [HR] = 1.18, 95% CI = 1.06 to 1.33) after adjusting for age, tumor size, treatment, node and receptor status. Comorbidity burden score was similarly associated with OS (HR = 1.08; 95% CI, 1.03 to 1.14).Among older women enrolled onto a clinical trial, comorbidity was associated with shorter OS, but not toxicity or relapse.

Authors
Klepin, HD; Pitcher, BN; Ballman, KV; Kornblith, AB; Hurria, A; Winer, EP; Hudis, C; Cohen, HJ; Muss, HB; Kimmick, GG
MLA Citation
Klepin, HD, Pitcher, BN, Ballman, KV, Kornblith, AB, Hurria, A, Winer, EP, Hudis, C, Cohen, HJ, Muss, HB, and Kimmick, GG. "Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance)." Journal of oncology practice 10.5 (September 2014): e285-e292.
PMID
25074878
Source
epmc
Published In
Journal of Oncology Practice
Volume
10
Issue
5
Publish Date
2014
Start Page
e285
End Page
e292
DOI
10.1200/jop.2014.001388

Treatment patterns for prostate cancer: comparison of Medicare claims data to medical record review.

BACKGROUND: As evidence-based guidelines increasingly define standards of care, the accurate reporting of patterns of treatment becomes critical to determine if appropriate care has been provided. We explore the level of agreement between claims and record abstraction for treatment regimens for prostate cancer. METHODS: Medicare claims data were linked to medical records abstraction using data from the Centers for Disease Control and Prevention's National Program of Cancer Registry-funded Breast and Prostate Patterns of Care study. The first course of therapy included surgery, radiation therapy (RT), and hormonal therapy with luteinizing hormone-releasing hormone agonists. RESULTS: The linked sample included 2765 men most (84.7%) of whom had stage II prostate cancer. Agreement was excellent for surgery (κ=0.92) and RT (κ=0.92) and lower for hormonal therapy (κ=0.71); however, most of the discrepancies were due to greater number of patients reported who received hormonal therapy in the claims database than in the medical records database. For some standard multicomponent management strategies sensitivities were high, for example, hormonal therapy with either combination RT (86.9%) or cryosurgery (96.6%). CONCLUSIONS: Medicare claims are sensitive for determining patterns of multicomponent care for prostate cancer and for detecting use of hormonal therapy when not reported in the medical records abstracts.

Authors
Fleming, ST; Hamilton, AS; Sabatino, SA; Kimmick, GG; Wu, X-C; Owen, JB; Huang, B; Hwang, W; Patterns of Care Study Group,
MLA Citation
Fleming, ST, Hamilton, AS, Sabatino, SA, Kimmick, GG, Wu, X-C, Owen, JB, Huang, B, Hwang, W, and Patterns of Care Study Group, . "Treatment patterns for prostate cancer: comparison of Medicare claims data to medical record review." Med Care 52.9 (September 2014): e58-e64.
PMID
23222532
Source
pubmed
Published In
Medical Care
Volume
52
Issue
9
Publish Date
2014
Start Page
e58
End Page
e64
DOI
10.1097/MLR.0b013e318277eba5

Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.

Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention.A randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads (n = 136), each comprised of a survivor of breast cancer (AJCC stage 0-III) and her adult biological daughter. All women had body mass indices ≥ 25 kg/m(2) and underwent in-person assessments at baseline, 6 months, and 12 months, with accelerometry and exercise capacity performed on a subset of individuals. All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss; exercise; and a nutrient-rich, low-energy density diet. A total of 25 dyads received individually tailored instruction (individual), 25 dyads received team-tailored instruction (TEAM), and 18 dyads received standardized brochures (control).The trial met its accrual target, experienced 90% retention, and caused no serious adverse events. Significant differences in baseline to 12-month changes were observed between individual versus control mothers for body mass index, weight, and waist circumference (WC); significant differences also were observed in the WC of corresponding daughters (P < .05). Significant differences were found between individual versus control and team versus control dyads for WC (P = .0002 and .018, respectively), minutes per week of physical activity (P = .031 and .036, respectively), and exercise capacity (P = .047 for both).Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members. For greater impact, more research is needed to expand this work beyond the mother-daughter dyad.

Authors
Demark-Wahnefried, W; Jones, LW; Snyder, DC; Sloane, RJ; Kimmick, GG; Hughes, DC; Badr, HJ; Miller, PE; Burke, LE; Lipkus, IM
MLA Citation
Demark-Wahnefried, W, Jones, LW, Snyder, DC, Sloane, RJ, Kimmick, GG, Hughes, DC, Badr, HJ, Miller, PE, Burke, LE, and Lipkus, IM. "Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters." Cancer 120.16 (August 2014): 2522-2534.
PMID
24804802
Source
epmc
Published In
Cancer
Volume
120
Issue
16
Publish Date
2014
Start Page
2522
End Page
2534
DOI
10.1002/cncr.28761

Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901.

Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation.A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor-positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively.Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003).Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.

Authors
Sheppard, VB; Faul, LA; Luta, G; Luta, G; Clapp, JD; Yung, RL; Wang, JH-Y; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, BN; Hudis, C; Winer, EP; Cohen, HJ; Muss, HB; Hurria, A; Mandelblatt, JS
MLA Citation
Sheppard, VB, Faul, LA, Luta, G, Luta, G, Clapp, JD, Yung, RL, Wang, JH-Y, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, BN, Hudis, C, Winer, EP, Cohen, HJ, Muss, HB, Hurria, A, and Mandelblatt, JS. "Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.22 (August 2014): 2318-2327.
PMID
24934786
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
22
Publish Date
2014
Start Page
2318
End Page
2327
DOI
10.1200/jco.2013.51.7367

Breast and ovarian cancer in the older woman.

Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.

Authors
Tew, WP; Muss, HB; Kimmick, GG; Von Gruenigen, VE; Lichtman, SM
MLA Citation
Tew, WP, Muss, HB, Kimmick, GG, Von Gruenigen, VE, and Lichtman, SM. "Breast and ovarian cancer in the older woman." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.24 (August 2014): 2553-2561. (Review)
PMID
25071129
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
24
Publish Date
2014
Start Page
2553
End Page
2561
DOI
10.1200/jco.2014.55.3073

Comparison of doxorubicin and cyclophosphamide versus single-agent paclitaxel as adjuvant therapy for breast cancer in women with 0 to 3 positive axillary nodes: CALGB 40101 (Alliance).

Optimal adjuvant chemotherapy for early-stage breast cancer balances efficacy and toxicity. We sought to determine whether single-agent paclitaxel (T) was inferior to doxorubicin and cyclophosphamide (AC), when each was administered for four or six cycles of therapy, and whether it offered less toxicity.Patients with operable breast cancer with 0 to 3 positive nodes were enrolled onto the study to address the noninferiority of single-agent T to AC, defined as the one-sided 95% upper-bound CI (UCB) of hazard ratio (HR) of T versus AC less than 1.30 for the primary end point of relapse-free survival (RFS). As a 2 × 2 factorial design, duration of therapy was also addressed and was previously reported.With 3,871 patients enrolled onto the trial, a median follow-up period of 6.1 years, and 437 RFS events, we achieved an HR of 1.26 (one sided 95% UCB, 1.48; favoring AC does not allow a conclusion of noninferiority of T with AC; UCB > 1.3). With 266 patient deaths, the HR for overall survival (OS) was 1.27 favoring AC (UCB, 1.56). The estimated absolute advantage of AC at 5 years is 3% for RFS (91 v 88%) and 1% for OS (95 v 94%). All nine treatment-related deaths were patients receiving AC and are included in the analyses of both RFS and OS. Hematologic toxicity was more common in patients treated with AC, and neuropathy was more common in patients treated with T.This trial did not show noninferiority of T to AC, a conclusion that is unlikely to change with additional events and follow-up. T was less toxic than AC.

Authors
Shulman, LN; Berry, DA; Cirrincione, CT; Becker, HP; Perez, EA; O'Regan, R; Martino, S; Shapiro, CL; Schneider, CJ; Kimmick, G; Burstein, HJ; Norton, L; Muss, H; Hudis, CA; Winer, EP
MLA Citation
Shulman, LN, Berry, DA, Cirrincione, CT, Becker, HP, Perez, EA, O'Regan, R, Martino, S, Shapiro, CL, Schneider, CJ, Kimmick, G, Burstein, HJ, Norton, L, Muss, H, Hudis, CA, and Winer, EP. "Comparison of doxorubicin and cyclophosphamide versus single-agent paclitaxel as adjuvant therapy for breast cancer in women with 0 to 3 positive axillary nodes: CALGB 40101 (Alliance)." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.22 (August 2014): 2311-2317.
PMID
24934787
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
22
Publish Date
2014
Start Page
2311
End Page
2317
DOI
10.1200/jco.2013.53.7142

Breast and ovarian cancer in the older woman.

Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.

Authors
Tew, WP; Muss, HB; Kimmick, GG; Von Gruenigen, VE; Lichtman, SM
MLA Citation
Tew, WP, Muss, HB, Kimmick, GG, Von Gruenigen, VE, and Lichtman, SM. "Breast and ovarian cancer in the older woman." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.24 (August 2014): 2553-2561.
PMID
25513243
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
24
Publish Date
2014
Start Page
2553
End Page
2561

The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer.

Diabetes severity may influence breast cancer treatment choices. We examined whether receipt of guideline-concordant breast cancer treatment varied with diabetes severity. Cancer registry data from seven states regarding 6,912 stage I-III breast cancers were supplemented by medical record abstraction and physician verification. We used logistic regression models to examine associations of diabetes severity with guideline-concordant locoregional treatment, adjuvant chemotherapy, and hormonal therapy adjusted for sociodemographics, comorbidity, and tumor characteristics. We defined guideline concordance using National Comprehensive Cancer Network guidelines, and diabetes and comorbidities using the Adult Comorbidity Evaluation-27 index. After adjustment, there was significant interaction of diabetes severity with age for locoregional treatment (p = 0.001), with many diabetic women under age 70 less frequently receiving guideline-concordant treatment than non-diabetic women. Among similarly aged women, guideline concordance was lower for women with mild diabetes in their late fifties through mid-sixties, and with moderate/severe diabetes in their late forties to early sixties. Among women in their mid-seventies to early eighties, moderate/severe diabetes was associated with increased guideline concordance. For adjuvant chemotherapy, moderate/severe diabetes was less frequently associated with guideline concordance than no diabetes [OR 0.58 (95 % CI 0.36-0.94)]. Diabetes was not associated with guideline-concordant hormonal treatment (p = 0.929). Some diabetic women were less likely to receive guideline-concordant treatment for stage I-III breast cancer than non-diabetic women. Diabetes severity was associated with lower guideline concordance for locoregional treatment among middle-aged women, and lower guideline concordance for adjuvant chemotherapy. Differences were not explained by comorbidity and may contribute to potentially worse breast cancer outcomes.

Authors
Sabatino, SA; Thompson, TD; Wu, X-C; Fleming, ST; Kimmick, GG; Trentham-Dietz, A; Cress, R; Anderson, RT
MLA Citation
Sabatino, SA, Thompson, TD, Wu, X-C, Fleming, ST, Kimmick, GG, Trentham-Dietz, A, Cress, R, and Anderson, RT. "The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer." Breast cancer research and treatment 146.1 (July 2014): 199-209.
PMID
24899083
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
146
Issue
1
Publish Date
2014
Start Page
199
End Page
209
DOI
10.1007/s10549-014-2998-3

Breast cancer and aging: results of the U13 conference breast cancer panel.

Breast cancer is predominantly a disease of older women, yet there is a knowledge gap due to the persisting misalignment between the age distribution of women with breast cancer and the age distribution of participants in clinical trials. The purpose of this report is to state the U13 conference breast cancer panel's recommendations regarding therapeutic clinical trials that will fill gaps in knowledge regarding the care of older patients with breast cancer. The U13 conference was a collaboration between the Cancer and Aging Research Group and the National Institute on Aging and the National Cancer Institute (NCI). Clinical trials should be developed for frail and vulnerable patients who would not enroll on the standard phase III trials, as well as efforts need to be made to increase enrollment of fit older patients on standard phase III trials. As a result of this conference, panel members are working with the NCI and cooperative groups to address these knowledge gaps. With the aging population and increasing incidence of breast cancer with age, it is essential to study the feasibility, toxicity, and efficacy of cancer therapy in this at-risk population.

Authors
Barginear, MF; Muss, H; Kimmick, G; Owusu, C; Mrozek, E; Shahrokni, A; Ballman, K; Hurria, A
MLA Citation
Barginear, MF, Muss, H, Kimmick, G, Owusu, C, Mrozek, E, Shahrokni, A, Ballman, K, and Hurria, A. "Breast cancer and aging: results of the U13 conference breast cancer panel." Breast cancer research and treatment 146.1 (July 2014): 1-6. (Review)
PMID
24847891
Source
epmc
Published In
Breast Cancer Research and Treatment
Volume
146
Issue
1
Publish Date
2014
Start Page
1
End Page
6
DOI
10.1007/s10549-014-2994-7

Comorbidity burden and guideline-concordant care for breast cancer.

OBJECTIVES: To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. DESIGN: Cross-sectional. SETTING: National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. PARTICIPANTS: Individuals with stage 0-III breast cancer. MEASUREMENTS: Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment. RESULTS: The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥ 50) and black race were associated with less guideline concordance, regardless of comorbidity level. CONCLUSION: When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.

Authors
Kimmick, G; Fleming, ST; Sabatino, SA; Wu, X-C; Hwang, W; Wilson, JF; Lund, MJ; Cress, R; Anderson, RT; Centers for Disease Control and Prevention National Program of Cancer Registry Patterns of Care Study Group,
MLA Citation
Kimmick, G, Fleming, ST, Sabatino, SA, Wu, X-C, Hwang, W, Wilson, JF, Lund, MJ, Cress, R, Anderson, RT, and Centers for Disease Control and Prevention National Program of Cancer Registry Patterns of Care Study Group, . "Comorbidity burden and guideline-concordant care for breast cancer." Journal of the American Geriatrics Society 62.3 (March 2014): 482-488.
PMID
24512124
Source
epmc
Published In
Journal of American Geriatrics Society
Volume
62
Issue
3
Publish Date
2014
Start Page
482
End Page
488
DOI
10.1111/jgs.12687

Comorbidity burden and guideline-concordant care for breast cancer

Objectives: To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. Design: Cross-sectional. Setting: National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. Participants: Individuals with stage 0-III breast cancer. Measurements: Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of paym ent. Results: The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥50) and black race were associated with less guideline concordance, regardless of comorbidity level. Conclusion: When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates. © 2014, The American Geriatrics Society.

Authors
Kimmick, G; Fleming, ST; Sabatino, SA; Wu, XC; Hwang, W; Wilson, JF; Lund, MJ; Cress, R; Anderson, RT
MLA Citation
Kimmick, G, Fleming, ST, Sabatino, SA, Wu, XC, Hwang, W, Wilson, JF, Lund, MJ, Cress, R, and Anderson, RT. "Comorbidity burden and guideline-concordant care for breast cancer." Journal of the American Geriatrics Society 62.3 (January 1, 2014): 482-488.
Source
scopus
Published In
Journal of American Geriatrics Society
Volume
62
Issue
3
Publish Date
2014
Start Page
482
End Page
488
DOI
10.1111/jgs.12687

The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer

Diabetes severity may influence breast cancer treatment choices. We examined whether receipt of guideline-concordant breast cancer treatment varied with diabetes severity. Cancer registry data from seven states regarding 6,912 stage I-III breast cancers were supplemented by medical record abstraction and physician verification. We used logistic regression models to examine associations of diabetes severity with guideline-concordant locoregional treatment, adjuvant chemotherapy, and hormonal therapy adjusted for sociodemographics, comorbidity, and tumor characteristics. We defined guideline concordance using National Comprehensive Cancer Network guidelines, and diabetes and comorbidities using the Adult Comorbidity Evaluation-27 index. After adjustment, there was significant interaction of diabetes severity with age for locoregional treatment (p = 0.001), with many diabetic women under age 70 less frequently receiving guideline-concordant treatment than non-diabetic women. Among similarly aged women, guideline concordance was lower for women with mild diabetes in their late fifties through mid-sixties, and with moderate/severe diabetes in their late forties to early sixties. Among women in their mid-seventies to early eighties, moderate/severe diabetes was associated with increased guideline concordance. For adjuvant chemotherapy, moderate/severe diabetes was less frequently associated with guideline concordance than no diabetes [OR 0.58 (95 % CI 0.36-0.94)]. Diabetes was not associated with guideline-concordant hormonal treatment (p = 0.929). Some diabetic women were less likely to receive guideline-concordant treatment for stage I-III breast cancer than non-diabetic women. Diabetes severity was associated with lower guideline concordance for locoregional treatment among middle-aged women, and lower guideline concordance for adjuvant chemotherapy. Differences were not explained by comorbidity and may contribute to potentially worse breast cancer outcomes. © 2014 Springer Science+Business Media.

Authors
Sabatino, SA; Thompson, TD; Wu, XC; Fleming, ST; Kimmick, GG; Trentham-Dietz, A; Cress, R; Anderson, RT
MLA Citation
Sabatino, SA, Thompson, TD, Wu, XC, Fleming, ST, Kimmick, GG, Trentham-Dietz, A, Cress, R, and Anderson, RT. "The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer." Breast Cancer Research and Treatment 146.1 (January 1, 2014): 199-209.
Source
scopus
Published In
Breast Cancer Research and Treatment
Volume
146
Issue
1
Publish Date
2014
Start Page
199
End Page
209
DOI
10.1007/s10549-014-2998-3

Treatment patterns for prostate cancer: Comparison of medicare claims data to medical record review

Background: As evidence-based guidelines increasingly define standards of care, the accurate reporting of patterns of treatment becomes critical to determine if appropriate care has been provided. We explore the level of agreement between claims and record abstraction for treatment regimens for prostate cancer. Methods: Medicare claims data were linked to medical records abstraction using data from the Centers for Disease Control and Prevention's National Program of Cancer Registry-funded Breast and Prostate Patterns of Care study. The first course of therapy included surgery, radiation therapy (RT), and hormonal therapy with luteinizing hormone-releasing hormone agonists. Results: The linked sample included 2765 men most (84.7%) of whom had stage II prostate cancer. Agreement was excellent for surgery (κ=0.92) and RT (κ=0.92) and lower for hormonal therapy (κ=0.71); however, most of the discrepancies were due to greater number of patients reported who received hormonal therapy in the claims database than in the medical records database. For some standard multicomponent management strategies sensitivities were high, for example, hormonal therapy with either combination RT (86.9%) or cryosurgery (96.6%). Conclusions: Medicare claims are sensitive for determining patterns of multicomponent care for prostate cancer and for detecting use of hormonal therapy when not reported in the medical record s abstracts. © 2012 by Lippincott Williams & Wilkins.

Authors
Fleming, ST; Hamilton, AS; Sabatino, SA; Kimmick, GG; Wu, XC; Owen, JB; Huang, B; Hwang, W
MLA Citation
Fleming, ST, Hamilton, AS, Sabatino, SA, Kimmick, GG, Wu, XC, Owen, JB, Huang, B, and Hwang, W. "Treatment patterns for prostate cancer: Comparison of medicare claims data to medical record review." Medical Care 52.9 (January 1, 2014). (Review)
Source
scopus
Published In
Medical Care
Volume
52
Issue
9
Publish Date
2014
DOI
10.1097/MLR.0b013e318277eba5

Getting beyond screening for frailty in older patients with cancer.

Authors
Kimmick, G; White, H
MLA Citation
Kimmick, G, and White, H. "Getting beyond screening for frailty in older patients with cancer." Journal of geriatric oncology 5.1 (January 2014): 8-10.
PMID
24484712
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
5
Issue
1
Publish Date
2014
Start Page
8
End Page
10
DOI
10.1016/j.jgo.2013.11.002

Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial.

BACKGROUND: To evaluate the safety and efficacy of moderate-to-high intensity aerobic training in breast cancer patients receiving neoadjuvant chemotherapy. METHODS: Twenty patients with stage IIB-IIIC operable breast cancer were randomly assigned to receive doxorubicin plus cyclophosphamide (AC) or AC in combination with aerobic training (AC + AET) (n = 10/group) for 12 weeks. The AC+ AET group performed three supervised aerobic cycle ergometry sessions per week at 60%-100% of exercise capacity (VO2peak). Safety outcomes included exercise testing as well as treatment- and exercise training-related adverse events (AEs), whereas efficacy outcomes included cardiopulmonary function and patient-reported outcomes (PROs) as measured by a cardiopulmonary exercise test (CPET) and Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. RESULTS: Twelve non-significant ECG abnormalities and three non-life threatening events occurred during CPET procedures. One AE was reported during aerobic training. There were no significant between group differences for clinician-documented events (e.g. pain, nausea) or hematological parameters (p's > 0.05). Attendance and adherence rates to aerobic training were 82% and 66%, respectively. Intention-to-treat analysis indicated that VO2peak increased by 2.6 ± 3.5 ml/kg/min (+ 13.3%) in the AC + AET group and decreased by 1.5 ± 2.2 ml/kg/min (-8.6%) in the AC group (between group difference, p = 0.001). FACT-B increased 11.1 points in the AC + AET group compared to a 1.5 point decrease in the AC group (between group difference, p = 0.685). CONCLUSION: Moderate-to-high intensity aerobic training when conducted with one-on-one supervision is a safe adjunct therapy associated with improvements in cardiopulmonary function and select PROs during neoadjuvant chemotherapy.

Authors
Hornsby, WE; Douglas, PS; West, MJ; Kenjale, AA; Lane, AR; Schwitzer, ER; Ray, KA; Herndon, JE; Coan, A; Gutierrez, A; Hornsby, KP; Hamilton, E; Wilke, LG; Kimmick, GG; Peppercorn, JM; Jones, LW
MLA Citation
Hornsby, WE, Douglas, PS, West, MJ, Kenjale, AA, Lane, AR, Schwitzer, ER, Ray, KA, Herndon, JE, Coan, A, Gutierrez, A, Hornsby, KP, Hamilton, E, Wilke, LG, Kimmick, GG, Peppercorn, JM, and Jones, LW. "Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: a phase II randomized trial." Acta Oncol 53.1 (January 2014): 65-74.
PMID
23957716
Source
pubmed
Published In
Acta Oncologica (Informa)
Volume
53
Issue
1
Publish Date
2014
Start Page
65
End Page
74
DOI
10.3109/0284186X.2013.781673

Breast cancer screening, area deprivation, and later-stage breast cancer in appalachia: Does geography matter?

Objective To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia. Data Source Central cancer registry data (2006-2008) from three Appalachian states were linked to Medicare claims and census data. Study Design Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. Principal Findings Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged >75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties. Conclusions Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk. © Health Research and Educational Trust.

Authors
Anderson, RT; Yang, T-C; Matthews, SA; Camacho, F; Kern, T; MacKley, HB; Kimmick, G; Louis, C; Lengerich, E; Yao, N
MLA Citation
Anderson, RT, Yang, T-C, Matthews, SA, Camacho, F, Kern, T, MacKley, HB, Kimmick, G, Louis, C, Lengerich, E, and Yao, N. "Breast cancer screening, area deprivation, and later-stage breast cancer in appalachia: Does geography matter?." Health Services Research 49.2 (2014): 546-567.
Source
scival
Published In
Health Services Research
Volume
49
Issue
2
Publish Date
2014
Start Page
546
End Page
567
DOI
10.1111/1475-6773.12108

Breast cancer and aging: Results of the U13 conference breast cancer panel

Breast cancer is predominantly a disease of older women, yet there is a knowledge gap due to the persisting misalignment between the age distribution of women with breast cancer and the age distribution of participants in clinical trials. The purpose of this report is to state the U13 conference breast cancer panel's recommendations regarding therapeutic clinical trials that will fill gaps in knowledge regarding the care of older patients with breast cancer. The U13 conference was a collaboration between the Cancer and Aging Research Group and the National Institute on Aging and the National Cancer Institute (NCI). Clinical trials should be developed for frail and vulnerable patients who would not enroll on the standard phase III trials, as well as efforts need to be made to increase enrollment of fit older patients on standard phase III trials. As a result of this conference, panel members are working with the NCI and cooperative groups to address these knowledge gaps. With the aging population and increasing incidence of breast cancer with age, it is essential to study the feasibility, toxicity, and efficacy of cancer therapy in this at-risk population. © 2014 Springer Science+Business Media.

Authors
Barginear, MF; Muss, H; Kimmick, G; Owusu, C; Mrozek, E; Shahrokni, A; Ballman, K; Hurria, A
MLA Citation
Barginear, MF, Muss, H, Kimmick, G, Owusu, C, Mrozek, E, Shahrokni, A, Ballman, K, and Hurria, A. "Breast cancer and aging: Results of the U13 conference breast cancer panel." Breast Cancer Research and Treatment 146.1 (2014): 1-6.
Source
scival
Published In
Breast Cancer Research and Treatment
Volume
146
Issue
1
Publish Date
2014
Start Page
1
End Page
6
DOI
10.1007/s10549-014-2994-7

Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy

© 2014, Springer-Verlag Berlin Heidelberg.Purpose: This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer.Methods: One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years).Results: Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p < 0.05). Self-efficacy for coping with symptoms moderated the relationship between physical symptoms and functional (B = 0.05, SE = 0.02, t = 2.67, p = 0.009) and emotional well-being (B = 0.03, SE = 0.01, t = 2.45, p = 0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being.Conclusions: Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.

Authors
Shelby, RA; Edmond, SN; Wren, AA; Keefe, FJ; Peppercorn, JM; Marcom, PK; Blackwell, KL; Kimmick, GG
MLA Citation
Shelby, RA, Edmond, SN, Wren, AA, Keefe, FJ, Peppercorn, JM, Marcom, PK, Blackwell, KL, and Kimmick, GG. "Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy." Supportive Care in Cancer 22.10 (2014): 2851-2859.
Source
scival
Published In
Supportive Care in Cancer
Volume
22
Issue
10
Publish Date
2014
Start Page
2851
End Page
2859
DOI
10.1007/s00520-014-2269-1

A phase II study of medroxyprogesterone acetate in patients with hormone receptor negative metastatic breast cancer: translational breast cancer research consortium trial 007

© 2014, Springer Science+Business Media New York.Preclinical data suggest that medroxyprogesterone acetate (MPA) has both anti-metastatic and anti-angiogenic activity in the absence of hormone receptors (HR). This phase II trial assessed the activity of MPA alone or in combination with low-dose chemotherapy in patients with metastatic HR-negative breast cancer. Postmenopausal women with HR-negative disease were eligible if they had not received more than 3 chemotherapy regimens for metastatic disease. All patients were treated with MPA 1,000–1,500 mg/day orally; patients in cohort two also received low-dose oral cyclophosphamide and methotrexate (ldCM, 50 mg/day and 2.5 mg twice daily on Days 1 and 2 each week). Tissue and circulating biomarkers were assessed serially. The primary endpoint was clinical benefit response defined as objective response or stable disease >6 months. Thirty patients were enrolled (14 MPA monotherapy; 16 MPA + ldCM); median age was 55 (35–80); nearly all had visceral involvement. Despite dose escalation in 90 % of patients, only 17 (57 %) patients ever achieved MPA trough concentrations >50 ng/ml. One patient developed grade 4 renal failure in the setting of rapid disease progression and dehydration. There were no objective responses. One patient in each cohort (~7 %) had stable disease for > 6 months. Skin Nm23 expression increased after 4 weeks of MPA + ldCM, but there were no significant changes in TSP-1, PAI-1 antigen, or PAI-1 activity. MPA had limited activity and does not warrant further development in patients with HR-negative advanced breast cancer. Poor bioavailability limited exposure despite dose escalation.

Authors
Miller, KD; Althouse, SK; Nabell, L; Rugo, H; Carey, L; Kimmick, G; Jones, DR; Merino, MJ; Steeg, PS
MLA Citation
Miller, KD, Althouse, SK, Nabell, L, Rugo, H, Carey, L, Kimmick, G, Jones, DR, Merino, MJ, and Steeg, PS. "A phase II study of medroxyprogesterone acetate in patients with hormone receptor negative metastatic breast cancer: translational breast cancer research consortium trial 007." Breast Cancer Research and Treatment 148.1 (2014): 99-106.
Source
scival
Published In
Breast Cancer Research and Treatment
Volume
148
Issue
1
Publish Date
2014
Start Page
99
End Page
106
DOI
10.1007/s10549-014-3131-3

Nab-paclitaxel/bevacizumab/carboplatin chemotherapy in first-line triple negative metastatic breast cancer

Background Triple negative metastatic breast cancer can be difficult to treat with primarily cytotoxic options. Nab-paclitaxel has demonstrated improved PFS and tolerability compared with standard cremophor-solubilized paclitaxel; based on this, we examined the efficacy and safety of combining weekly nab-paclitaxel with carboplatin and bevacizumab in TNMBC. Patients and Methods In this phase II, multicenter trial, patients with first-line TNMBC received nab-paclitaxel (100 mg/m 2 ) and carboplatin (area under the curve = 2) on days 1, 8, 15, and bevacizumab (10 mg/kg) on days 1 and 15 of a 28-day cycle. The primary end point was safety and tolerability and secondary end points included PFS, ORR, and CBR. PFS was calculated using the Kaplan-Meier method. Results Between July 16, 2007, and October 3, 2011, 34 patients were enrolled at 4 centers. Median age was 50.0 (range, 30-76) years and 77% (n = 26) of patients received previous adjuvant therapy. Median PFS was 9.2 months (95% confidence interval [CI], 7.8-25.1 months). The CBR was 94% (95% CI, 80%-99%), and ORR was 85% (95% CI, 69%-95%) for the combination. The regimen was well tolerated with the most common grade 3/4 adverse events being neutropenia (n = 18; 53%) and thrombocytopenia (n = 6; 18%), with other serous events including 1 grade 3 and 1 grade 4 thrombotic event and 1 febrile neutropenia. Conclusion The combination of nab-paclitaxel, bevacizumab, and carboplatin as first-line treatment for TNMBC was efficacious and well tolerated. The PFS, CBR, and ORR, and tolerability of the regimen, compares favorably with other standard first-line therapies. © 2013 Elsevier Inc. All rights reserved.

Authors
Hamilton, E; Kimmick, G; Hopkins, J; Marcom, PK; Rocha, G; Welch, R; Broadwater, G; Blackwell, K
MLA Citation
Hamilton, E, Kimmick, G, Hopkins, J, Marcom, PK, Rocha, G, Welch, R, Broadwater, G, and Blackwell, K. "Nab-paclitaxel/bevacizumab/carboplatin chemotherapy in first-line triple negative metastatic breast cancer." Clinical Breast Cancer 13.6 (December 1, 2013): 416-420.
Source
scopus
Published In
Clinical Breast Cancer
Volume
13
Issue
6
Publish Date
2013
Start Page
416
End Page
420
DOI
10.1016/j.clbc.2013.08.003

Nab-paclitaxel/bevacizumab/carboplatin chemotherapy in first-line triple negative metastatic breast cancer.

BACKGROUND: Triple negative metastatic breast cancer can be difficult to treat with primarily cytotoxic options. Nab-paclitaxel has demonstrated improved PFS and tolerability compared with standard cremophor-solubilized paclitaxel; based on this, we examined the efficacy and safety of combining weekly nab-paclitaxel with carboplatin and bevacizumab in TNMBC. PATIENTS AND METHODS: In this phase II, multicenter trial, patients with first-line TNMBC received nab-paclitaxel (100 mg/m(2)) and carboplatin (area under the curve = 2) on days 1, 8, 15, and bevacizumab (10 mg/kg) on days 1 and 15 of a 28-day cycle. The primary end point was safety and tolerability and secondary end points included PFS, ORR, and CBR. PFS was calculated using the Kaplan-Meier method. RESULTS: Between July 16, 2007, and October 3, 2011, 34 patients were enrolled at 4 centers. Median age was 50.0 (range, 30-76) years and 77% (n = 26) of patients received previous adjuvant therapy. Median PFS was 9.2 months (95% confidence interval [CI], 7.8-25.1 months). The CBR was 94% (95% CI, 80%-99%), and ORR was 85% (95% CI, 69%-95%) for the combination. The regimen was well tolerated with the most common grade 3/4 adverse events being neutropenia (n = 18; 53%) and thrombocytopenia (n = 6; 18%), with other serous events including 1 grade 3 and 1 grade 4 thrombotic event and 1 febrile neutropenia. CONCLUSION: The combination of nab-paclitaxel, bevacizumab, and carboplatin as first-line treatment for TNMBC was efficacious and well tolerated. The PFS, CBR, and ORR, and tolerability of the regimen, compares favorably with other standard first-line therapies.

Authors
Hamilton, E; Kimmick, G; Hopkins, J; Marcom, PK; Rocha, G; Welch, R; Broadwater, G; Blackwell, K
MLA Citation
Hamilton, E, Kimmick, G, Hopkins, J, Marcom, PK, Rocha, G, Welch, R, Broadwater, G, and Blackwell, K. "Nab-paclitaxel/bevacizumab/carboplatin chemotherapy in first-line triple negative metastatic breast cancer." Clin Breast Cancer 13.6 (December 2013): 416-420.
PMID
24099649
Source
pubmed
Published In
Clinical Breast Cancer
Volume
13
Issue
6
Publish Date
2013
Start Page
416
End Page
420
DOI
10.1016/j.clbc.2013.08.003

Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy.

Aerobic exercise training (AET) is an effective adjunct therapy to attenuate the adverse side-effects of adjuvant chemotherapy in women with early breast cancer. Whether AET interacts with the antitumor efficacy of chemotherapy has received scant attention. We carried out a pilot study to explore the effects of AET in combination with neoadjuvant doxorubicin-cyclophosphamide (AC+AET), relative to AC alone, on: (i) host physiology [exercise capacity (VO2 peak), brachial artery flow-mediated dilation (BA-FMD)], (ii) host-related circulating factors [circulating endothelial progenitor cells (CEP) cytokines and angiogenic factors (CAF)], and (iii) tumor phenotype [tumor blood flow ((15)O-water PET), tissue markers (hypoxia and proliferation), and gene expression] in 20 women with operable breast cancer. AET consisted of three supervised cycle ergometry sessions/week at 60% to 100% of VO2 peak, 30 to 45 min/session, for 12 weeks. There was significant time × group interactions for VO2 peak and BA-FMD, favoring the AC+AET group (P < 0.001 and P = 0.07, respectively). These changes were accompanied by significant time × group interactions in CEPs and select CAFs [placenta growth factor, interleukin (IL)-1β, and IL-2], also favoring the AC+AET group (P < 0.05). (15)O-water positron emission tomography (PET) imaging revealed a 38% decrease in tumor blood flow in the AC+AET group. There were no differences in any tumor tissue markers (P > 0.05). Whole-genome microarray tumor analysis revealed significant differential modulation of 57 pathways (P < 0.01), including many that converge on NF-κB. Data from this exploratory study provide initial evidence that AET can modulate several host- and tumor-related pathways during standard chemotherapy. The biologic and clinical implications remain to be determined.

Authors
Jones, LW; Fels, DR; West, M; Allen, JD; Broadwater, G; Barry, WT; Wilke, LG; Masko, E; Douglas, PS; Dash, RC; Povsic, TJ; Peppercorn, J; Marcom, PK; Blackwell, KL; Kimmick, G; Turkington, TG; Dewhirst, MW
MLA Citation
Jones, LW, Fels, DR, West, M, Allen, JD, Broadwater, G, Barry, WT, Wilke, LG, Masko, E, Douglas, PS, Dash, RC, Povsic, TJ, Peppercorn, J, Marcom, PK, Blackwell, KL, Kimmick, G, Turkington, TG, and Dewhirst, MW. "Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy." Cancer Prev Res (Phila) 6.9 (September 2013): 925-937.
PMID
23842792
Source
pubmed
Published In
Cancer Prevention Research
Volume
6
Issue
9
Publish Date
2013
Start Page
925
End Page
937
DOI
10.1158/1940-6207.CAPR-12-0416

Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907.

Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function.

Authors
Freedman, RA; Pitcher, B; Keating, NL; Ballman, KV; Mandelblatt, J; Kornblith, AB; Kimmick, GG; Hurria, A; Winer, EP; Hudis, CA; Cohen, HJ; Muss, HB; Alliance for Clinical Trials in Oncology,
MLA Citation
Freedman, RA, Pitcher, B, Keating, NL, Ballman, KV, Mandelblatt, J, Kornblith, AB, Kimmick, GG, Hurria, A, Winer, EP, Hudis, CA, Cohen, HJ, Muss, HB, and Alliance for Clinical Trials in Oncology, . "Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907." Breast Cancer Res Treat 139.2 (June 2013): 607-616.
PMID
23681403
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
139
Issue
2
Publish Date
2013
Start Page
607
End Page
616
DOI
10.1007/s10549-013-2562-6

Multidisciplinary care of patients with early-stage breast cancer.

There is a compelling need for close coordination and integration of multiple specialties in the management of patients with early-stage breast cancer. Optimal patient care and outcomes depend on the sequential and often simultaneous participation and dialogue between specialists in imaging, pathologic and molecular diagnostic and prognostic stratification, and the therapeutic specialties of surgery, radiation oncology, and medical oncology. These are but a few of the various disciplines needed to provide modern, sophisticated management. The essential role for coordinated involvement of the entire health care team in optimal management of patients with early-stage breast cancer is likely to increase further.

Authors
Lyman, GH; Baker, J; Geradts, J; Horton, J; Kimmick, G; Peppercorn, J; Pruitt, S; Scheri, RP; Hwang, ES
MLA Citation
Lyman, GH, Baker, J, Geradts, J, Horton, J, Kimmick, G, Peppercorn, J, Pruitt, S, Scheri, RP, and Hwang, ES. "Multidisciplinary care of patients with early-stage breast cancer." Surg Oncol Clin N Am 22.2 (April 2013): 299-317. (Review)
PMID
23453336
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
2
Publish Date
2013
Start Page
299
End Page
317
DOI
10.1016/j.soc.2012.12.005

Breast Cancer Screening, Area Deprivation, and Later Stage Breast Cancer in Appalachia: Does Geography Matter?

Objective: To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia. Data Source: Central cancer registry data (2006-2008) from three Appalachian states were linked to Medicare claims and census data. Study Design: Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. Principal Findings: Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged >75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties. Conclusions: Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk. © Health Research and Educational Trust.

Authors
Anderson, RT; Yang, T-C; Matthews, SA; Camacho, F; Kern, T; Mackley, HB; Kimmick, G; Louis, C; Lengerich, E; Yao, N
MLA Citation
Anderson, RT, Yang, T-C, Matthews, SA, Camacho, F, Kern, T, Mackley, HB, Kimmick, G, Louis, C, Lengerich, E, and Yao, N. "Breast Cancer Screening, Area Deprivation, and Later Stage Breast Cancer in Appalachia: Does Geography Matter?." Health Services Research (2013).
PMID
24117371
Source
scival
Published In
Health Services Research
Publish Date
2013
DOI
10.1111/1475-6773.12108

Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women

OBJECTIVES: Although clinical trials have demonstrated the benefit of adjuvant hormonal therapy for hormone receptor-positive breast cancer, it is not known whether poor medication adherence might impact outcomes, particularly in the context of a low-income population traditionally underrepresented in clinical trials. We explored the relationship between adherence to tamoxifen or selective aromatase inhibitors with cancer recurrence and death in a low-income, Medicaid-insured population. METHODS: Using a Medicaid claims-tumor registry and National Death Index data, we evaluated adherence to adjuvant hormonal therapy [defined by the medication possession ratio (MPR)], cancer recurrence, and cancer-specific survival for female breast cancer diagnosed from 1998 to 2002, in North Carolina. Multivariate Cox proportional hazards models and logistic regression models were used to examine the role of adherence on cancer recurrence and survival. RESULTS: The sample consisted of 857 cases, mean age 67.7 years, 56.9% white, 60.9% local stage, with a mean follow-up of 4.4 years. Mean first-year MPR was 77%. MPR adherence was not significantly associated with cancer-related death [adjusted hazards ratio=1.18 (95% confidence interval, 0.54-2.59)], or recurrence [adjusted odds ratio=1.49 (95% confidence interval, 0.78-2.84)]. There was also no significant interaction between adherence and use of concurrent CYP2D6 enzyme inhibitors. DISCUSSION: Hormonal therapy adherence was not associated with breast cancer outcomes in this low-income population with relatively poor adherence. Although suboptimal adherence is considered to be an important clinical problem, its effects on breast cancer outcomes may be masked by patient genetic profiles, tumor characteristics, and behavioral factors. Copyright © 2012 by Lippincott Williams &Wilkins.

Authors
Weaver, KE; Camacho, F; Hwang, W; Anderson, R; Kimmick, G
MLA Citation
Weaver, KE, Camacho, F, Hwang, W, Anderson, R, and Kimmick, G. "Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women." American Journal of Clinical Oncology: Cancer Clinical Trials 36.2 (2013): 181-187.
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
36
Issue
2
Publish Date
2013
Start Page
181
End Page
187
DOI
10.1097/COC.0b013e3182436ec1

Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907

Cognitive changes in older women receiving chemotherapy are poorly understood. We examined self-reported cognitive function for older women who received adjuvant chemotherapy on Cancer and Leukemia Group B (CALGB) 49907. CALGB 49907 randomized 633 women aged ≥65 with stage I-III breast cancer to standard adjuvant chemotherapy (cyclophosphamide-methotrexate-5-fluorouracil or doxorubicin-cyclophosphamide) versus capecitabine. We examined self-reported cognitive function in 297 women (CALGB 361002) who enrolled on the quality of life substudy and had no gross impairment on cognitive screening. Women were evaluated using an 18-item instrument at six time points (baseline through 24 months). At each time point for each patient, we calculated a cognitive function score (CFS) defined as the mean response of items 1-18 and defined impairment as a score >1.5 standard deviations above the overall average baseline score. Differences in scores by patient characteristics were evaluated using a Kruskal-Wallis test. A linear mixed-effects model was used to assess CFSs by treatment over time. Among 297 women, the median age was 71.5 (range 65-85) and 73 % had performance status of 0. Baseline depression and fatigue were reported in 6 and 14 % of patients, respectively. The average CFS at baseline was 2.08 (corresponding to "normal ability"), and baseline cognitive function did not differ by treatment regimen (p = 0.350). Over 24 months, women reported minimal changes at each time point and insignificant differences by treatment arm were observed. In a healthy group of older women, chemotherapy was not associated with longitudinal changes in self-reported cognitive function. © 2013 Springer Science+Business Media New York.

Authors
Freedman, RA; Pitcher, B; Keating, NL; Ballman, KV; Mandelblatt, J; Kornblith, AB; Kimmick, GG; Hurria, A; Winer, EP; Hudis, CA; Cohen, HJ; Muss, HB
MLA Citation
Freedman, RA, Pitcher, B, Keating, NL, Ballman, KV, Mandelblatt, J, Kornblith, AB, Kimmick, GG, Hurria, A, Winer, EP, Hudis, CA, Cohen, HJ, and Muss, HB. "Cognitive function in older women with breast cancer treated with standard chemotherapy and capecitabine on Cancer and Leukemia Group B 49907." Breast Cancer Research and Treatment 139.2 (2013): 607-616.
Source
scival
Published In
Breast Cancer Research and Treatment
Volume
139
Issue
2
Publish Date
2013
Start Page
607
End Page
616
DOI
10.1007/s10549-013-2562-6

A planned, prospective comparison of short-term quality of life outcomes among older breast cancer patients treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901

Objectives: Patients ≥ 65 years old ("older") are often not included in randomized clinical trials (RCT), but when they are, care in an RCT might improve quality of life (QoL). We conducted a prospective comparison of QoL among older women receiving standard chemotherapy from the same cooperative group physicians in an RCT vs. an observational study ("off-trial"). Methods: Older women with invasive, non-metastatic breast cancer (n = 150 RCT; 530 off-trial) were included. Linear mixed-effects models tested associations between chemotherapy on- vs. off-trial and changes in EORTC (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) QoL scores over 24 months, controlling for pre-treatment QoL, age, education, tumor factors, comorbidity, and other covariates. Results: Anthracycline regimens were used by 58% of women treated on-trial vs. 54% of those treated off-trial. Women in the RCT reported an adjusted mean increase of 13.7 points (95% CI 10.2, 17.1) in global QoL at 24 months (vs. mid-treatment), while women treated off-trial had only an adjusted improvement of 7.0 points (95% CI 3.5, 10.4; p = .007 for difference in mean changes). Women in the RCT had significantly greater improvement in emotional function than those treated off-trial, controlling for baseline; they also had greater reductions in therapy side effects and fatigue at 24 months than women off-trial, controlling for covariates. Conclusion: There may be different QoL trajectories for older women undergoing breast cancer chemotherapy on- vs. off-trial. If confirmed, the results suggest that the extra monitoring and communication within an RCT could provide the infrastructure for interventions to address symptoms and improve QoL for the growing older cancer population. © 2013 Elsevier Inc. All rights reserved.

Authors
Mandelblatt, JS; Makgoeng, SB; Luta, G; Hurria, A; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, B; Winer, EP; al, E
MLA Citation
Mandelblatt, JS, Makgoeng, SB, Luta, G, Hurria, A, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, B, Winer, EP, and al, E. "A planned, prospective comparison of short-term quality of life outcomes among older breast cancer patients treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901." Journal of Geriatric Oncology (2013).
PMID
24472479
Source
scival
Published In
Journal of Geriatric Oncology
Publish Date
2013
DOI
10.1016/j.jgo.2013.05.004

A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901

Objectives: Patients ≥. 65. years old ("older") are often not included in randomized clinical trials (RCT), but when they are, care in an RCT might improve quality of life (QoL). We conducted a prospective comparison of QoL among older women receiving standard chemotherapy from the same cooperative group physicians in an RCT vs. an observational study ("off-trial"). Methods: Older women with invasive, non-metastatic breast cancer (n. =. 150 RCT; 530 off-trial) were included. Linear mixed-effects models tested associations between chemotherapy on- vs. off-trial and changes in EORTC (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire) QoL scores over 24. months, controlling for pre-treatment QoL, age, education, tumor factors, comorbidity, and other covariates. Results: Anthracycline regimens were used by 58% of women treated on-trial vs. 54% of those treated off-trial. Women in the RCT reported an adjusted mean increase of 13.7 points (95% CI 10.2, 17.1) in global QoL at 24. months (vs. mid-treatment), while women treated off-trial had only an adjusted improvement of 7.0 points (95% CI 3.5, 10.4; p. =. .007 for difference in mean changes). Women in the RCT had significantly greater improvement in emotional function than those treated off-trial, controlling for baseline; they also had greater reductions in therapy side effects and fatigue at 24. months than women off-trial, controlling for covariates. Conclusion: There may be different QoL trajectories for older women undergoing breast cancer chemotherapy on- vs. off-trial. If confirmed, the results suggest that the extra monitoring and communication within an RCT could provide the infrastructure for interventions to address symptoms and improve QoL for the growing older cancer population. © 2013 Elsevier Inc.

Authors
Mandelblatt, JS; Makgoeng, SB; Luta, G; Hurria, A; Kimmick, G; Isaacs, C; Tallarico, M; Barry, WT; Pitcher, B; Winer, EP; Hudis, C; Cohen, HJ; Muss, HB
MLA Citation
Mandelblatt, JS, Makgoeng, SB, Luta, G, Hurria, A, Kimmick, G, Isaacs, C, Tallarico, M, Barry, WT, Pitcher, B, Winer, EP, Hudis, C, Cohen, HJ, and Muss, HB. "A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901." Journal of Geriatric Oncology 4.4 (2013): 353-361.
Source
scival
Published In
Journal of Geriatric Oncology
Volume
4
Issue
4
Publish Date
2013
Start Page
353
End Page
361
DOI
10.1016/j.jgo.2013.05.004

Symptom communication in breast cancer: relationships of holding back and self-efficacy for communication to symptoms and adjustment.

Adjuvant endocrine therapy improves overall survival for women with breast cancer. However, side effects may compromise patients' quality of life (QOL). This study examined how two communication variables (self-efficacy for symptom communication [SE] and holding back from discussing cancer-related concerns [HB]) relate to QOL, pain and menopausal symptoms. Participants with breast cancer (N = 61) completed questionnaires regarding symptoms, communication, and QOL. SE was positively related to QOL and negatively related to pain interference. HB from discussing cancer-related concerns was related negatively to QOL and positively to pain interference. HB mediated the relationship between SE and QOL as well as between SE and pain interference. Increased SE is beneficial among women on endocrine therapy for breast cancer. Future research should determine if interventions to improve SE are feasible and can improve QOL and symptom tolerability.

Authors
Edmond, SN; Shelby, RA; Kimmick, GG; Marcom, PK; Peppercorn, JM; Keefe, FJ
MLA Citation
Edmond, SN, Shelby, RA, Kimmick, GG, Marcom, PK, Peppercorn, JM, and Keefe, FJ. "Symptom communication in breast cancer: relationships of holding back and self-efficacy for communication to symptoms and adjustment." J Psychosoc Oncol 31.6 (2013): 698-711.
PMID
24175903
Source
pubmed
Published In
Journal of Psychosocial Oncology
Volume
31
Issue
6
Publish Date
2013
Start Page
698
End Page
711
DOI
10.1080/07347332.2013.835023

Defining care provided for breast cancer based on medical record review or Medicare claims: information from the Centers for Disease Control and Prevention Patterns of Care Study.

BACKGROUND: Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care. METHODS: From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity. RESULTS: The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73). CONCLUSIONS: Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.

Authors
Fleming, ST; Kimmick, GG; Sabatino, SA; Cress, RD; Wu, X-C; Trentham-Dietz, A; Huang, B; Hwang, W; Liff, JM; Patterns of Care Study Group,
MLA Citation
Fleming, ST, Kimmick, GG, Sabatino, SA, Cress, RD, Wu, X-C, Trentham-Dietz, A, Huang, B, Hwang, W, Liff, JM, and Patterns of Care Study Group, . "Defining care provided for breast cancer based on medical record review or Medicare claims: information from the Centers for Disease Control and Prevention Patterns of Care Study." Ann Epidemiol 22.11 (November 2012): 807-813.
PMID
22948184
Source
pubmed
Published In
Annals of Epidemiology
Volume
22
Issue
11
Publish Date
2012
Start Page
807
End Page
813
DOI
10.1016/j.annepidem.2012.08.001

(AI) Can't get off my chair.

Authors
Kanesvaran, R; White, HK; Kimmick, GG
MLA Citation
Kanesvaran, R, White, HK, and Kimmick, GG. "(AI) Can't get off my chair." J Am Geriatr Soc 60.10 (October 2012): 1978-1979. (Letter)
PMID
23057452
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
10
Publish Date
2012
Start Page
1978
End Page
1979
DOI
10.1111/j.1532-5415.2012.04177.x

Similar survival with single-agent capecitabine or taxane in first-line therapy for metastatic breast cancer.

Capecitabine is often offered as a first-line chemotherapy option for metastatic breast cancer (MBC). In this study, we compare characteristics of and survival among women prescribed first-line capecitabine or taxane monotherapy for MBC. Women receiving first-line chemotherapy for MBC from 1998 to 2005 were identified from the North Carolina tumor registry linked with Medicaid and Medicare claims records, and were followed through the end of 2005 with survival data from the National Death Index. T Tests and Chi-square tests were used to compare baseline characteristics. Overall survival and cancer-specific survival were examined using Cox proportional hazard modeling. There were 257 patients with MBC starting first-line chemotherapy with capecitabine (n=71) or a taxane (n=186). No differences in age, race, or Charlson comorbidity status were observed between groups. Hormone receptor negative tumors (31.0 vs. 17.7%, p=0.02) and patients insured by Medicaid (28 vs. 12%, p=0.002) were more prevalent in the capecitabine group. Time from metastasis to first-line chemotherapy was longer in the capecitabine group (52 vs. 26% began after 3 months, p<0.001). In multivariate analysis, treatment received was not associated with overall or cancer-specific survival. Among standard demographics, age was the only factor significantly associated with overall survival (HR 1.02, p=04). In this population-based study, women who received capecitabine as first-line treatment for MBC were more often hormone receptor negative and insured by Medicaid. In multivariate analysis, first-line capecitabine and taxane for MBC yielded similar overall and cancer-specific survival outcomes.

Authors
Kamal, AH; Camacho, F; Anderson, R; Wei, W; Balkrishnan, R; Kimmick, G
MLA Citation
Kamal, AH, Camacho, F, Anderson, R, Wei, W, Balkrishnan, R, and Kimmick, G. "Similar survival with single-agent capecitabine or taxane in first-line therapy for metastatic breast cancer." Breast Cancer Res Treat 134.1 (July 2012): 371-378.
PMID
22460617
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
134
Issue
1
Publish Date
2012
Start Page
371
End Page
378
DOI
10.1007/s10549-012-2037-1

A randomized trial of exercise on well-being and function following breast cancer surgery: the RESTORE trial.

OBJECTIVES: This study aimed to determine the effect of a moderate, tailored exercise program on health-related quality of life, physical function, and arm volume in women receiving treatment for nonmetastatic breast cancer. METHODS: Women who were within 4-12 weeks of surgery for stage I-III breast cancer were randomized to center-based exercise and lymphedema education intervention or patient education. Functional assessment of cancer therapy-breast cancer (FACT-B), 6-min walk, and arm volume were performed at 3-month intervals through 18 months. Repeated measures analysis of covariance was used to model the total meters walked over time, FACT-B scores, and arm volume. Models were adjusted for baseline measurement, baseline affected arm volume, number of nodes removed, age, self-reported symptoms, baseline SF-12 mental and physical component scores, visit, and treatment group. RESULTS: Of the recruited 104 women, 82 completed all 18 months. Mean age (range) was 53.6 (32-82) years; 88% were Caucasian; 45% were employed full time; 44% were overweight; and 28% obese. Approximately, 46% had breast-conserving surgery; 79% had axillary node dissection; 59% received chemotherapy; and 64% received radiation. The intervention resulted in an average increase of 34.3 ml (SD = 12.8) versus patient education (p = 0.01). Changes in FACT-B scores and arm volumes were not significantly different. CONCLUSIONS: With this early exercise intervention after breast cancer diagnosis, a significant improvement was achieved in physical function, with no decline in health-related quality of life or detrimental effect on arm volume. IMPLICATIONS FOR CANCER SURVIVORS: Starting a supervised exercise regimen that is tailored to an individual's strength and stamina within 3 months following breast cancer surgery appears safe and may hasten improvements in physical functioning.

Authors
Anderson, RT; Kimmick, GG; McCoy, TP; Hopkins, J; Levine, E; Miller, G; Ribisl, P; Mihalko, SL
MLA Citation
Anderson, RT, Kimmick, GG, McCoy, TP, Hopkins, J, Levine, E, Miller, G, Ribisl, P, and Mihalko, SL. "A randomized trial of exercise on well-being and function following breast cancer surgery: the RESTORE trial." J Cancer Surviv 6.2 (June 2012): 172-181.
PMID
22160629
Source
pubmed
Published In
Journal of Cancer Survivorship
Volume
6
Issue
2
Publish Date
2012
Start Page
172
End Page
181
DOI
10.1007/s11764-011-0208-4

Adjuvant Radiation and Outcomes After Breast Conserving Surgery in Publicly Insured Patients.

OBJECTIVES: Epidemiologic studies report that lack of adjuvant radiation (RT) after breast conserving surgery (BCS) is associated with higher short-term mortality. It is generally accepted that adjuvant RT decreases risk of breast cancer recurrence and thereby lowers long-term mortality; here, we explore reasons for its relationship to short-term mortality. MATERIALS AND METHODS: We studied 1,583 publically insured women who had BCS between 1998 and 2002 (mean 71.8 years, range 27-101), of whom 1,346 (85%) received RT. Multivariate analyses with Cox Proportional Hazards and Logistic Regression models included: age; race; comorbidity; insurance status; tumor size; number of nodes positive; hormone receptor status; receipt of radiation; adjuvant chemotherapy; preventive care - including mammography, Pap smear and primary care visits; and hospitalization. RESULTS: At a mean follow-up of 52.8 months, overall mortality was significantly lower in those who received RT (HR 0.45, p<0.0001) and higher with older age (HR 1.05, p<0.0001) and greater comorbidity (HR 1.16, p=0.0007). Local recurrence was less with receipt of optimal radiation (HR 0.47; p=0.03). Breast cancer event, as determined by a clinically logical algorithm to detect breast cancer recurrence and death, however, was not significantly associated with receipt of RT (OR 1.32, p=0.2). CONCLUSION: These results imply that the higher short-term mortality in women not receiving RT after BCS is related to factors other than breast cancer recurrence.

Authors
Kimmick, GG; Camacho, F; Hwang, W; Mackley, H; Stewart, J; Anderson, RT
MLA Citation
Kimmick, GG, Camacho, F, Hwang, W, Mackley, H, Stewart, J, and Anderson, RT. "Adjuvant Radiation and Outcomes After Breast Conserving Surgery in Publicly Insured Patients." Journal of geriatric oncology 3.2 (April 2012): 138-146.
PMID
22712029
Source
epmc
Published In
Journal of Geriatric Oncology
Volume
3
Issue
2
Publish Date
2012
Start Page
138
End Page
146
DOI
10.1016/j.jgo.2012.01.004

Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers.

PURPOSE: For breast cancer, guidelines direct the delivery of adjuvant systemic therapy on the basis of lymph node status, histology, tumor size, grade, and hormonal receptor status. We explored how race/ethnicity, insurance, census tract-level poverty and education, and hospital Commission on Cancer (CoC) status were associated with the receipt of guideline-concordant adjuvant systemic therapy. METHODS: Locoregional breast cancers diagnosed in 2004 (n = 6,734) were from the National Program of Cancer Registries-funded seven-state Patterns of Care study of the Centers for Disease Control and Prevention. Predictors of guideline-concordant (receiving/not receiving) adjuvant systemic therapy, according to National Comprehensive Cancer Network Guidelines, were explored by logistic regression. RESULTS: Overall, 35% of women received nonguideline chemotherapy, 12% received nonguideline regimens, and 20% received nonguideline hormonal therapy. Significant predictors of nonguideline chemotherapy included Medicaid insurance (odds ratio [OR], 0.66; 95% CI, 0.50 to 0.86), high-poverty areas (OR, 0.77; 95% CI, 0.62 to 0.96), and treatment at non-CoC hospitals (OR, 0.69; 95% CI, 0.56 to 0.85), with adjustment for age, registry, and clinical variables. Predictors of nonguideline regimens among chemotherapy recipients included lack of insurance (OR, 0.47; 95% CI, 0.25 to 0.92), high-poverty areas (OR, 0.71; 95% CI, 0.51 to 0.97), and low-education areas (OR, 0.65; 95% CI, 0.48 to 0.89) after adjustment. Living in high-poverty areas (OR, 0.78; 95% CI, 0.64 to 0.96) and treatment at non-CoC hospitals (OR, 0.68; 95% CI, 0.55 to 0.83) predicted nonguideline hormonal therapy after adjustment. ORs for poverty, education, and insurance were attenuated in the full models. CONCLUSION: Sociodemographic and hospital factors are associated with guideline-concordant use of systemic therapy for breast cancer. The identification of modifiable factors that lead to nonguideline treatment may reduce disparities in breast cancer survival.

Authors
Wu, X-C; Lund, MJ; Kimmick, GG; Richardson, LC; Sabatino, SA; Chen, VW; Fleming, ST; Morris, CR; Huang, B; Trentham-Dietz, A; Lipscomb, J
MLA Citation
Wu, X-C, Lund, MJ, Kimmick, GG, Richardson, LC, Sabatino, SA, Chen, VW, Fleming, ST, Morris, CR, Huang, B, Trentham-Dietz, A, and Lipscomb, J. "Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers." J Clin Oncol 30.2 (January 10, 2012): 142-150.
PMID
22147735
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
30
Issue
2
Publish Date
2012
Start Page
142
End Page
150
DOI
10.1200/JCO.2011.36.8399

Six cycles of doxorubicin and cyclophosphamide or paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and leukemia group B 40101

Purpose: The ideal duration of adjuvant chemotherapy for patients with lower risk primary breast cancer is not known. Cancer and Leukemia Group B trial 40101 was conducted using a phase III factorial design to define whether six cycles of a chemotherapy regimen are superior to four cycles. We also sought to determine whether paclitaxel (T) is as efficacious as doxorubicin/ cyclophosphamide (AC), but with reduced toxicity. Patients and Methods: Between 2002 and 2008, the study enrolled women with operable breast cancer and zero to three positive nodes. Patients were randomly assigned to either four or six cycles of either AC or T. Study stratifiers were estrogen receptor/progesterone receptor (ER/PgR), human epidermal growth factor receptor 2 (HER2), and menopausal status. After 2003, all treatment was administered in dose-dense fashion. The primary efficacy end point was relapse-free survival (RFS). Results: A total of 3,171 patients were enrolled; 94% were node-negative and 6% had one to three positive nodes. At a median follow-up of 5.3 years, the 4-year RFS was 90.9% and 91.8% for six and four cycles, respectively. The adjusted hazard ratio (HR) of six to four cycles regarding RFS was 1.03 (95% CI, 0.84 to 1.28; P = .77). The 4-year OS was 95.3% and 96.3% for six and four cycles, respectively, with an HR of six to four cycles of 1.12 (95% CI, 0.84 to 1.49; P = .44). There was no interaction between treatment duration and chemotherapy regimen, ER/PgR, or HER2 status on RFS or OS. Conclusion: For women with resected primary breast cancer and zero to three positive nodes, we found no evidence that extending chemotherapy regimens of AC or single-agent T from four to six cycles improves clinical outcome. © 2012 by American Society of Clinical Oncology.

Authors
Shulman, LN; Cirrincione, CT; Berry, DA; Becker, HP; Perez, EA; O'Regan, R; Martino, S; Atkins, JN; Mayer, E; Schneider, CJ; Kimmick, G; Norton, L; Muss, H; Winer, EP; Hudis, C
MLA Citation
Shulman, LN, Cirrincione, CT, Berry, DA, Becker, HP, Perez, EA, O'Regan, R, Martino, S, Atkins, JN, Mayer, E, Schneider, CJ, Kimmick, G, Norton, L, Muss, H, Winer, EP, and Hudis, C. "Six cycles of doxorubicin and cyclophosphamide or paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and leukemia group B 40101." Journal of Clinical Oncology 30.33 (2012): 4071-4076.
PMID
22826271
Source
scival
Published In
Journal of Clinical Oncology
Volume
30
Issue
33
Publish Date
2012
Start Page
4071
End Page
4076
DOI
10.1200/JCO.2011.40.6405

Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women

OBJECTIVES: Although clinical trials have demonstrated the benefit of adjuvant hormonal therapy for hormone receptor-positive breast cancer, it is not known whether poor medication adherence might impact outcomes, particularly in the context of a low-income population traditionally underrepresented in clinical trials. We explored the relationship between adherence to tamoxifen or selective aromatase inhibitors with cancer recurrence and death in a low-income, Medicaid-insured population. METHODS: Using a Medicaid claims-tumor registry and National Death Index data, we evaluated adherence to adjuvant hormonal therapy [defined by the medication possession ratio (MPR)], cancer recurrence, and cancer-specific survival for female breast cancer diagnosed from 1998 to 2002, in North Carolina. Multivariate Cox proportional hazards models and logistic regression models were used to examine the role of adherence on cancer recurrence and survival. RESULTS: The sample consisted of 857 cases, mean age 67.7 years, 56.9% white, 60.9% local stage, with a mean follow-up of 4.4 years. Mean first-year MPR was 77%. MPR adherence was not significantly associated with cancer-related death [adjusted hazards ratio=1.18 (95% confidence interval, 0.54-2.59)], or recurrence [adjusted odds ratio=1.49 (95% confidence interval, 0.78-2.84)]. There was also no significant interaction between adherence and use of concurrent CYP2D6 enzyme inhibitors. DISCUSSION: Hormonal therapy adherence was not associated with breast cancer outcomes in this low-income population with relatively poor adherence. Although suboptimal adherence is considered to be an important clinical problem, its effects on breast cancer outcomes may be masked by patient genetic profiles, tumor characteristics, and behavioral factors.

Authors
Weaver, KE; Camacho, F; Hwang, W; Anderson, R; Kimmick, G
MLA Citation
Weaver, KE, Camacho, F, Hwang, W, Anderson, R, and Kimmick, G. "Adherence to adjuvant hormonal therapy and its relationship to breast cancer recurrence and survival among low-income women." American Journal of Clinical Oncology (2012).
PMID
22314001
Source
scival
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Publish Date
2012
DOI
10.1097/COC.0b013e3182436ec1

Phase II trial of dasatinib in patients with metastatic breast cancer using real-time pharmacodynamic tissue biomarkers of Src inhibition to escalate dosing.

PURPOSE: A phase II study of dasatinib, an inhibitor of multiple oncogenic tyrosine kinases including Src, was conducted to evaluate 16-week progression-free rate and tolerability in patients with previously treated metastatic breast cancer (MBC). Real-time assessment of potential tissue biomarkers of Src inhibition was used to optimize dosing. EXPERIMENTAL DESIGN: Eligibility criteria required that patients have measurable MBC, biopsiable tumor, and unlimited prior therapies. For the analysis of change in protein biomarkers of Src inhibition, focal adhesion kinase, paxillin, and p-Src, patients underwent metastatic biopsies at baseline and 4 weeks. Patients who tolerated the starting dose of dasatinib (50 or 70 mg orally twice daily) for the first 28-day cycle, and displayed suboptimal Src inhibition, were escalated to a higher dose (70 or 100 mg). RESULTS: The trial was closed early with 31 patients because of a statistical boundary that required at least 4 (13%) patients without disease progression to continue accrual. These 31 patients had a median of 2 prior lines of chemotherapy for MBC. The most notable toxicity was pleural effusions in 16 patients (52%). Twenty patients had evaluable metastatic biopsies. None of the tumors showed the predefined optimal level of Src inhibition at week 4. CONCLUSIONS: Single-agent dasatinib did not exhibit significant antitumor activity in patients with heavily pretreated MBC. There were no clinically meaningful decreases before and after dasatinib exposure between exploratory tissue biomarkers of Src inhibition which may be attributable to challenges in defining biomarker endpoints for multitargeted tyrosine kinase inhibitors.

Authors
Herold, CI; Chadaram, V; Peterson, BL; Marcom, PK; Hopkins, J; Kimmick, GG; Favaro, J; Hamilton, E; Welch, RA; Bacus, S; Blackwell, KL
MLA Citation
Herold, CI, Chadaram, V, Peterson, BL, Marcom, PK, Hopkins, J, Kimmick, GG, Favaro, J, Hamilton, E, Welch, RA, Bacus, S, and Blackwell, KL. "Phase II trial of dasatinib in patients with metastatic breast cancer using real-time pharmacodynamic tissue biomarkers of Src inhibition to escalate dosing." Clin Cancer Res 17.18 (September 15, 2011): 6061-6070.
PMID
21810917
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
17
Issue
18
Publish Date
2011
Start Page
6061
End Page
6070
DOI
10.1158/1078-0432.CCR-11-1071

Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: A companion study to cancer and leukemia group B 49907

Purpose: A phase III trial (Cancer and Leukemia Group B CALGB-49907) was conducted to test whether older patients with early-stage breast cancer would have equivalent relapse-free and overall survival with capecitabine compared with standard chemotherapy. The quality of life (QoL) substudy tested whether capecitabine treatment would be associated with a better QoL than standard chemotherapy. Patients and Methods: QoL was assessed in 350 patients randomly assigned to either standard chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] or doxorubicin and cyclophosphamide [AC]; n = 182) or capecitabine (n = 168). Patients were interviewed by telephone before treatment (baseline), midtreatment, within 1 month post-treatment, and at 12, 18, and 24 months postbaseline by using questionnaires from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), a breast systemic adverse effects scale (EORTC BR23), and the Hospital Anxiety and Depression Scale (HADS). Results: Compared with patients who were treated with standard chemotherapy, patients who were treated with capecitabine had significantly better QoL, role function, and social function, fewer systemic adverse effects, less psychological distress, and less fatigue during and at the completion of treatment (P ≤ .005). Capecitabine treatment was associated with less nausea, vomiting, and constipation and with better appetite than standard treatment (P ≤ .004), but worse hand-foot syndrome and diarrhea (P < .005). These differences all resolved by 12 months. Conclusion: Standard chemotherapy was superior to capecitabine in improving relapse-free and overall survival for older women with early-stage breast cancer. Although capecitabine was associated with better QoL during treatment, QoL was similar for both groups at 1 year. The brief period of poorer QoL with standard treatment is a modest price to pay for a chance at improved survival. © 2011 by American Society of Clinical Oncology.

Authors
Kornblith, AB; Lan, L; Archer, L; Partridge, A; Kimmick, G; Hudis, C; Winer, E; Casey, R; Bennett, S; Cohen, HJ; Muss, HB
MLA Citation
Kornblith, AB, Lan, L, Archer, L, Partridge, A, Kimmick, G, Hudis, C, Winer, E, Casey, R, Bennett, S, Cohen, HJ, and Muss, HB. "Quality of life of older patients with early-stage breast cancer receiving adjuvant chemotherapy: A companion study to cancer and leukemia group B 49907." Journal of Clinical Oncology 29.8 (2011): 1022-1028.
PMID
21300923
Source
scival
Published In
Journal of Clinical Oncology
Volume
29
Issue
8
Publish Date
2011
Start Page
1022
End Page
1028
DOI
10.1200/JCO.2010.29.9859

Cardiovascular complications of breast cancer therapy in older adults.

Older adults frequently have pre-existing and cancer-related risk factors for cardiovascular toxicity from cancer treatment. In this review, we discuss the risk factors and strategies for prevention and management of cardiovascular complications in older women with breast cancer.

Authors
Shenoy, C; Klem, I; Crowley, AL; Patel, MR; Winchester, MA; Owusu, C; Kimmick, GG
MLA Citation
Shenoy, C, Klem, I, Crowley, AL, Patel, MR, Winchester, MA, Owusu, C, and Kimmick, GG. "Cardiovascular complications of breast cancer therapy in older adults." Oncologist 16.8 (2011): 1138-1143. (Review)
PMID
21737575
Source
pubmed
Published In
The oncologist
Volume
16
Issue
8
Publish Date
2011
Start Page
1138
End Page
1143
DOI
10.1634/theoncologist.2010-0348

Adjuvant chemotherapy for breast cancer in older women: Emerging evidence to aid in decision making

To prevent breast cancer-related recurrence and death, adjuvant therapy, including chemotherapy, is given. The decision to deliver chemotherapy requires careful weighing of the risk of toxicity versus the estimated benefit. The risk and benefit are based on information from clinical trials, statistical models, and past clinical experience . Compared to younger patients, it is perceived that older patients have cancers that are lower risk, gain less benefit from chemotherapy, and are at higher risk of toxicity. There is now strong evidence that healthy older women tolerate treatment and stand to gain the same benefits from treatment as do younger women. Numeric age alone, therefore, does not justify withholding adjuvant chemotherapy. New tools to aid in the decision are needed. Fortunately, the expected great increase in the size of the geriatric population spawned the field of geriatric oncology and the development of brief, practical versions of the Comprehensive Geriatric Assessment (CGA) for use in busy oncology clinics are in sight. It is time for us to incorporate elements of the CGA into practice, to systematically identify older patients at substantial risk of toxicity. For frail older women with breast cancer, no therapy or less toxic therapies can be considered, some of which are suggested herein. In addition, as always in oncology, physicians and patients should look for and participate in clinical trials that will define how to treat cancer, especially in older patients, in the future.© Springer Science+Business Media, LLC 2011.

Authors
Kimmick, G
MLA Citation
Kimmick, G. "Adjuvant chemotherapy for breast cancer in older women: Emerging evidence to aid in decision making." Current Treatment Options in Oncology 12.3 (2011): 286-301.
PMID
21638199
Source
scival
Published In
Current Treatment Options in Oncology
Volume
12
Issue
3
Publish Date
2011
Start Page
286
End Page
301
DOI
10.1007/s11864-011-0159-z

Developing a claim-based version of the ACE-27 comorbidity index: A comparison with medical record review

ObjectiveS: The adult comorbidity evaluation (ACE-27) is a medical record-based comorbidity index that predicts survival among various types of cancer patients. The purpose of this study was to compare the medical record-based ACE-27 instrument to a newly developed administrative claim-based ACE-27 measure. Study Design and Setting: Cross-sectional study of 4,300 breast and prostate cancer patients from the Centers for Disease Control and Prevention Patterns of Care Study. Results: Comorbidities with the highest concordance were diabetes (sensitivity=84.6%, κ=0.58 for breast cancer patients; sensitivity=0.764, κ=0.54 for prostate cancer patients), and hypertension (sensitivity=78.5%, κ=0.32 for breast cancer patients; sensitivity=69.6%, κ=0.28 for prostate cancer patients). Diseases with fair or moderate agreement in one or both cancer sites include congestive heart failure, arrhythmia, hypertension, respiratory diseases, hepatic disease, renal disease, dementia, and neuromuscular disease. For overall indices, agreement was fair but with high sensitivities in the collapsed indices, and the highest sensitivities in the lowest level of decompensation. Conclusions: The ACE-27 comorbidity score derived from administrative claims data provides a tool to examine the relationship between comorbidity, cancer diagnosis, and outcomes in future epidemiologic research, particularly when medical record review is logistically impossible. The classification of most comorbidities into 2 or 3 levels of severity within a claim-based measure is a major development. Future research should be directed toward refining the measure with a longer review period or different paradigms for diagnosis identification, and testing the predictive ability of the measure in terms of survival, complications, or other outcomes of care. Copyright © 2011 by Lippincott Williams & Wilkins.

Authors
Fleming, ST; Sabatino, SA; Kimmick, G; Cress, R; Wu, X-C; Trentham-Dietz, A; Huang, B; Hwang, W; Liff, J
MLA Citation
Fleming, ST, Sabatino, SA, Kimmick, G, Cress, R, Wu, X-C, Trentham-Dietz, A, Huang, B, Hwang, W, and Liff, J. "Developing a claim-based version of the ACE-27 comorbidity index: A comparison with medical record review." Medical Care 49.8 (2011): 752-760.
PMID
21490514
Source
scival
Published In
Medical Care
Volume
49
Issue
8
Publish Date
2011
Start Page
752
End Page
760
DOI
10.1097/MLR.0b013e318215d7dd

Factor V Leiden mutation and thromboembolism risk in women receiving adjuvant tamoxifen for breast cancer.

BACKGROUND: Tamoxifen use has been associated with increased risk of thromboembolic events (TEs) in women with breast cancer and women at high risk for the disease. Factor V Leiden (FVL) is the most common inherited clotting factor mutation and also confers increased thrombosis risk. We investigated whether FVL was associated with TE risk in women with early-stage breast cancer who took adjuvant tamoxifen. METHODS: A case-control study was conducted among 34 Cancer and Leukemia Group B (CALGB) institutions. We matched each of 124 women who had experienced a documented TE while taking adjuvant tamoxifen for breast cancer (but who were not necessarily on a CALGB treatment trial) to two control subjects (women who took adjuvant tamoxifen but did not experience TE) by age at diagnosis (+/-5 years). DNA from blood was analyzed for FVL mutations. Conditional logistic regression was used to estimate odds ratios (ORs) and to evaluate other potential factors associated with TE and tamoxifen use. All P values are based on two-sided tests. RESULTS: FVL mutations were identified in 23 (18.5%) case and 12 (4.8%) control subjects (OR = 4.66, 95% confidence interval = 2.14 to 10.14, P < .001). In the multivariable model, FVL mutation was associated with TE (OR = 4.73, 95% confidence interval = 2.10 to 10.68, P < .001). Other statistically significant factors associated with TE risk were personal history of TE and smoking. CONCLUSIONS: Among women taking adjuvant tamoxifen for early-stage breast cancer, those who had a TE were nearly five times more likely to carry a FVL mutation than those who did not have a TE. Postmenopausal women should be evaluated for the FVL mutation before prescription of adjuvant tamoxifen if a positive test would alter therapeutic decision making.

Authors
Garber, JE; Halabi, S; Tolaney, SM; Kaplan, E; Archer, L; Atkins, JN; Edge, S; Shapiro, CL; Dressler, L; Paskett, ED; Kimmick, G; Orcutt, J; Scalzo, A; Winer, E; Levine, E; Shahab, N; Berliner, N; Cancer and Leukemia Group B,
MLA Citation
Garber, JE, Halabi, S, Tolaney, SM, Kaplan, E, Archer, L, Atkins, JN, Edge, S, Shapiro, CL, Dressler, L, Paskett, ED, Kimmick, G, Orcutt, J, Scalzo, A, Winer, E, Levine, E, Shahab, N, Berliner, N, and Cancer and Leukemia Group B, . "Factor V Leiden mutation and thromboembolism risk in women receiving adjuvant tamoxifen for breast cancer." J Natl Cancer Inst 102.13 (July 7, 2010): 942-949.
PMID
20554945
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
102
Issue
13
Publish Date
2010
Start Page
942
End Page
949
DOI
10.1093/jnci/djq211

Breast cancer patients' treatment expectations after exposure to the decision aid program adjuvant online: the influence of numeracy.

The decision aid called ''Adjuvant Online'' (Adjuvant! for short) helps breast cancer patients make treatment decisions by providing numerical estimates of treatment efficacy (e.g., 10-y relapse or survival). Studies exploring how patients' numeracy interacts with the estimates provided by Adjuvant! are lacking. Pooling across 2 studies totaling 105 women with estrogen receptor-positive, early-stage breast cancer, the authors explored patients' treatment expectations, perceived benefit from treatments, and confidence of personal benefit from treatments. Patients who were more numerate were more likely to provide estimates of cancer-free survival that matched the estimates provided by Adjuvant! for each treatment option compared with patients with lower numeracy (odds ratios of 1.6 to 2.4). As estimates of treatment efficacy provided by Adjuvant! increased, so did patients' estimates of cancer-free survival (0.37 > r(s) > 0.48) and their perceptions of treatment benefit from hormonal therapy (r(s) = 0.28) and combined therapy (r(s) = 0.27). These relationships were significantly more pronounced for those with higher numeracy, especially for perceived benefit of combined therapy. Results suggest that numeracy influences a patient's ability to interpret numerical estimates of treatment efficacy from decision aids such as Adjuvant!.

Authors
Lipkus, IM; Peters, E; Kimmick, G; Liotcheva, V; Marcom, P
MLA Citation
Lipkus, IM, Peters, E, Kimmick, G, Liotcheva, V, and Marcom, P. "Breast cancer patients' treatment expectations after exposure to the decision aid program adjuvant online: the influence of numeracy." Med Decis Making 30.4 (July 2010): 464-473.
PMID
20160070
Source
pubmed
Published In
Medical Decision Making
Volume
30
Issue
4
Publish Date
2010
Start Page
464
End Page
473
DOI
10.1177/0272989X09360371

A phase 1B dose escalation trial of Scutellaria barbata (BZL101) for patients with metastatic breast cancer.

The purpose of this study was to determine the safety and maximum tolerated dose (MTD) of BZL101 (FDA IND# 59,521), an orally delivered aqueous extract from the herb Scutellaria barbata, in women with metastatic breast cancer (MBC). The trial was an open-label, phase 1B, multicenter, dose escalation study. Eligible patients had histologically confirmed breast cancer and measurable stage IV disease. The standard phase 1 "3 + 3" study design was used to determine the MTD. Primary endpoints were toxicity and MTD of BZL101. Secondary outcomes included efficacy based on RECIST criteria. A total of 27 women with a median of 2 prior chemotherapy treatments for metastatic disease were treated in four different dose cohorts. Grade 3 and 4 adverse events (AEs) were uncommon. Dose-limiting toxicities included the following: grade 4 AST elevation, grade 3 diarrhea, grade 3 fatigue, and grade 3 rib pain. Fourteen patients were evaluable according to Response Evaluation Criteria in Solid Tumors. Investigator assessment classified three patients with stable disease for >120 days (21%). One patient was on BZL101 for 449 days and remains stable for 700 + days. Independent radiology review identified three patients with objective tumor regression (>0% and <30%). The MTD was not reached, thus per protocol, the MTD was defined as the maximum administered dose of BZL101 40 g/day. In conclusion, oral administration of BZL101 was safe, well tolerated, and showed promising clinical evidence of anticancer activity in this heavily pretreated population of women with MBC.

Authors
Perez, AT; Arun, B; Tripathy, D; Tagliaferri, MA; Shaw, HS; Kimmick, GG; Cohen, I; Shtivelman, E; Caygill, KA; Grady, D; Schactman, M; Shapiro, CL
MLA Citation
Perez, AT, Arun, B, Tripathy, D, Tagliaferri, MA, Shaw, HS, Kimmick, GG, Cohen, I, Shtivelman, E, Caygill, KA, Grady, D, Schactman, M, and Shapiro, CL. "A phase 1B dose escalation trial of Scutellaria barbata (BZL101) for patients with metastatic breast cancer." Breast Cancer Res Treat 120.1 (February 2010): 111-118.
PMID
20054647
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
120
Issue
1
Publish Date
2010
Start Page
111
End Page
118
DOI
10.1007/s10549-009-0678-5

Management of breast cancer in older adults

© Cambridge University Press 2010. Introduction Increasing age is a major risk factor for the development of breast cancer. While approximately 1 in 233 women are diagnosed with breast cancer in the fourth decade of life, the risk increases to 1 in 27 in the seventh decade (Figure 7.1). Thus over half the women diagnosed with breast cancer in the United States annually are 65 years of age and older. With the aging of the population in the United States, and given that breast cancer represents the second leading cause of cancer death for women in the United States, optimizing management of this disease in this population of patients is of utmost importance. As a generality, less aggressive tumor biologic characteristics are associated with breast cancers in older women. For instance, several prognostic features of tumors in older women often indicate favorable prognosis: steroid receptor positivity, lower proliferativ e rate, diploid (vs. aneuploid), and low histologic grade. In addition, p53 is more often normal, and less expression of epidermal growth factor receptor and c-erbB2 are observed in this population of patients. Though ductal histology remains the most common regardless of age, the more indolent histologies, such as tubular, mucinous, and papillary, are observed with greater frequency in older patients than in younger patients. Despite these more favorable tumor characteristics, breast cancer survival is poorer and breast cancer–specific mortality is greater for women over age 75 as compared with younger patients.

Authors
Shayne, M; Kimmick, G
MLA Citation
Shayne, M, and Kimmick, G. "Management of breast cancer in older adults." (January 1, 2010): 89-109. (Chapter)
Source
scopus
Publish Date
2010
Start Page
89
End Page
109
DOI
10.1017/CBO9780511763182.007

Breast cancer adjuvant chemotherapy decisions in older women: The role of patient preference and interactions with physicians

Purpose: Breast cancer chemotherapy decisions in patients ≥ 65 years old (older) are complex because of comorbidity, toxicity, and limited data on patient preference. We examined relationships between preferences and chemotherapy use. Methods: Older women (n = 934) diagnosed with invasive (≥ 1 cm), nonmetastatic breast cancer from 2004 to 2008 were recruited from 53 cooperative group sites. Data were collected from patient interviews (87% complete), physician survey (93% complete), and charts. Logistic regression and multiple imputation methods were used to assess associations between chemotherapy and independent variables. Chemotherapy use was also evaluated according to the following two groups: indicated (estrogen receptor [ER] negative and/or node positive) and possibly indicated (ER positive and node negative). Results: Mean patient age was 73 years (range, 65 to 100 years). Unadjusted chemotherapy rates were 69% in the indicated group and 16% in the possibly indicated group. Women who would choose chemotherapy for an increase in survival of ≤ 12 months had 3.9 times (95% CI, 2.4 to 6.3 times; P < .001) higher odds of receiving chemotherapy than women with lower preferences, controlling for covariates. Stronger preferences were seen when chemotherapy could be indicated (odds ratio [OR] = 7.7; 95% CI, 3.8 to 16; P < .001) than when treatment might be possibly indicated (OR = 1.9; 95% CI, 1.0 to 3.8; P = .06). Higher patient rating of provider communication was also related to chemotherapy use in the possibly indicated group (OR = 1.9 per 5-point increase in communication score; 95% CI, 1.4 to 2.8; P < .001) but not in the indicated group (P = .15). Conclusion: Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal. © 2010 by American Society of Clinical Oncology.

Authors
Mandelblatt, JS; Sheppard, VB; Hurria, A; Kimmick, G; Isaacs, C; Taylor, KL; Kornblith, AB; Noone, A-M; Luta, G; Tallarico, M; Barry, WT; Hunegs, L; Zon, R; Naughton, M; Winer, E; Hudis, C; Edge, SB; Cohen, HJ; Muss, H
MLA Citation
Mandelblatt, JS, Sheppard, VB, Hurria, A, Kimmick, G, Isaacs, C, Taylor, KL, Kornblith, AB, Noone, A-M, Luta, G, Tallarico, M, Barry, WT, Hunegs, L, Zon, R, Naughton, M, Winer, E, Hudis, C, Edge, SB, Cohen, HJ, and Muss, H. "Breast cancer adjuvant chemotherapy decisions in older women: The role of patient preference and interactions with physicians." Journal of Clinical Oncology 28.19 (2010): 3146-3153.
PMID
20516438
Source
scival
Published In
Journal of Clinical Oncology
Volume
28
Issue
19
Publish Date
2010
Start Page
3146
End Page
3153
DOI
10.1200/JCO.2009.24.3295

Hot flashes in breast cancer survivors and an association with calcium supplement use

Aims: In breast cancer survivors, we aimed to describe the frequency of hot flashes and night sweats, frequency and type of treatment, and the association of hot flashes and use of calcium supplements. Methods: Charts of breast cancer survivors were reviewed for information about hot flashes, treatment for hot flashes, and calcium supplementation. Associations between variables were explored using the Chi-square test and Fisher's Exact test. Results: Eighty-six charts were reviewed. Mean age of the women was 58 years and 79% were postmenopausal. Forty-two (49%) of women had hot flashes and 18 (21%) had night sweats. Thirty-one (36%) were treated for hot flashes. Treatment included selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (n = 19), clonidine (n = 7), Bellergal-S® (n = 8), sleep-aid (n = 7), and other (n = 5). Calcium supplementation was recorded in 31%. Of women with hot flashes, 44% took calcium supplements; of women without hot flashes, 18% took calcium supplements (Chi-square P = 0.02). Conclusion: Hot flashes were recorded in 49% of this group of primarily postmenopausal breast cancer survivors. Women with hot flashes were more likely to be taking calcium supplements. Further exploration of the association between hot flashes and calcium supplementation is warranted. © 2010 Kimmick et al, publisher and licensee Dove Medical Press Ltd.

Authors
Kimmick, G; Broadwater, G; Vitolins, M
MLA Citation
Kimmick, G, Broadwater, G, and Vitolins, M. "Hot flashes in breast cancer survivors and an association with calcium supplement use." International Journal of Women's Health 2.1 (2010): 291-294.
Source
scival
Published In
International Journal of Women's Health
Volume
2
Issue
1
Publish Date
2010
Start Page
291
End Page
294
DOI
10.2147/IJWH.S12335

Patient and provider determinants associated with the prescription of adjuvant hormonal therapies following a diagnosis of breast cancer in Medicaid-enrolled patients.

PURPOSE: This study examined patient and provider characteristics associated with being prescribed an aromatase inhibitor (AI) vs tamoxifen-only therapy among a cohort of postmenopausal North Carolina Medicaid enrollees diagnosed with hormone receptor-positive breast cancer. METHODS: A logistic regression model was built to determine the odds of an individual ever receiving an AI during the study period using data from the Linked North Carolina Central Cancer Registry-Medicaid Claims database. RESULTS: A total of 452 patients were included, of which 307 (67.9%) and 145 (32.1%) received tamoxifen only and AI (alone or in combination) therapy, respectively. Results of the final logistic model revealed that odds of receiving an AI generally increased over the study period; however, patients who lived in urban areas had 1.86 (95% CI, 1.20-2.89) times the odds of ever receiving some form of AI therapy compared to patients who lived in rural areas. Additionally, patients with distant stage or unstaged breast cancer (opposed to local stage) had 2.15 (95% CI, 1.39-3.32) times the odds of ever receiving an AI. CONCLUSIONS: Results suggest that the use of AI therapy is becoming more widespread over time; however, differences in the type of antiestrogenic treatment prescribed based on urban/rural status may represent disparities in access to advanced care. Furthermore, it may be the case that women with local-stage breast cancer are not being treated aggressively enough with novel antiestrogenic drug therapies.

Authors
McLaughlin, JM; Balkrishnan, R; Paskett, ED; Kimmick, GG; Anderson, RT
MLA Citation
McLaughlin, JM, Balkrishnan, R, Paskett, ED, Kimmick, GG, and Anderson, RT. "Patient and provider determinants associated with the prescription of adjuvant hormonal therapies following a diagnosis of breast cancer in Medicaid-enrolled patients." J Natl Med Assoc 101.11 (November 2009): 1112-1118.
PMID
19998639
Source
pubmed
Published In
Journal of the National Medical Association
Volume
101
Issue
11
Publish Date
2009
Start Page
1112
End Page
1118

Fifteen-year median follow-up results after neoadjuvant doxorubicin, followed by mastectomy, followed by adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) followed by radiation for stage III breast cancer: a phase II trial (CALGB 8944).

PURPOSE: To describe long-term results of a multimodality strategy for stage III breast cancer utilizing neoadjuvant doxorubicin followed by mastectomy, CMF, and radiotherapy. PATIENTS AND METHODS: Women with biopsy-proven, clinical stage III breast cancer and adequate organ function were eligible. Neoadjuvant doxorubicin (30 mg/m(2) days 1-3, every 28 days for 4 cycles) was followed by mastectomy, in stable or responding patients. Sixteen weeks of postoperative CMF followed (continuous oral cyclophosphamide (2 mg/kg/day); methotrexate (0.7 mg/kg IV) and fluorouracil (12 mg/kg IV) weekly, weeks 1-8, and than biweekly, weeks 9-16). Radiation therapy followed adjuvant chemotherapy. RESULTS: Clinical response rate was 71% (79/111, 95% CI = 62-79%), with 19% complete clinical response. Pathologic complete response was 5% (95% CI = 2-11%). Median follow-up is 15.6 years. Half of the patients progressed by 2.2 years; half died by 5.4 years (range 6 months-15 years). The hazard of dying was greatest in the first 5 years after diagnosis and declined thereafter. Time to progression and overall survival were predicted by number of pathologically involved lymph nodes (TTP: HR [10 vs. 1 node] 2.40, 95% CI = 1.63-3.53, P < 0.0001; OS: HR 2.50, 95% CI = 1.74-3.58, P < 0.0001). CONCLUSIONS: After multimodality treatment for locally advanced breast cancer, long-term survival was correlated with the number of pathologically positive lymph nodes, but not to clinical response. The hazard of death was highest during the first 5 years after diagnosis and declined thereafter, indicating a possible intermediate endpoint for future trials of neoadjuvant treatment.

Authors
Kimmick, GG; Cirrincione, C; Duggan, DB; Bhalla, K; Robert, N; Berry, D; Norton, L; Lemke, S; Henderson, IC; Hudis, C; Winer, E; Cancer and Leukemia Group B,
MLA Citation
Kimmick, GG, Cirrincione, C, Duggan, DB, Bhalla, K, Robert, N, Berry, D, Norton, L, Lemke, S, Henderson, IC, Hudis, C, Winer, E, and Cancer and Leukemia Group B, . "Fifteen-year median follow-up results after neoadjuvant doxorubicin, followed by mastectomy, followed by adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) followed by radiation for stage III breast cancer: a phase II trial (CALGB 8944)." Breast Cancer Res Treat 113.3 (February 2009): 479-490.
PMID
18306034
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
113
Issue
3
Publish Date
2009
Start Page
479
End Page
490
DOI
10.1007/s10549-008-9943-2

Cost impact of oral capecitabine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer

Objective: Few studies have examined the costs associated with differing first-line chemotherapy regimens in patients with metastatic breast cancer (MBC). This study compares the relative cost impact of women starting first-line chemotherapy with capecitabine versus taxanes. Methods: Women receiving first-line chemotherapy for MBC from 1998 to 2002 were identified from a hybrid North Carolina Medicaid-claims-tumour registry linked database and Medicare records, and were followed through to 2005 with claims data. Statistical t- and chi-square tests were used to compare baseline characteristics between patients who received first-line chemotherapy with capecitabine versus taxanes. Projected mean costs for 12 months continuous eligibility were estimated using an ordinary least squares linear regression. Overall cost impact of capecitabine after start of therapy was then examined using a multivariate log-linear regression model. Results: While patients starting taxanes had significantly lower total costs in the pre-index year than patients starting capecitabine (mean: $20,042 vs. $35,538, p<0.001), in the post-index year, the patients on taxanes experienced significantly higher healthcare utilisation and associated costs compared to patients on capecitabine (mean: $43,353 vs. $35,842, p=0.0089). The differences were primarily attributable to lower expenses in chemotherapy related claims and fewer visit days to outpatient settings for patients on capecitabine. After adjustment with propensity scores and other confounders, the capecitabine group was associated with 32% lower healthcare costs compared to the taxane group (p=0.0001). Conclusions: In this population-based study, women who received capecitabine as first-line treatment for MBC had significantly lower costs compared to women starting taxane therapy. © Informa UK Ltd 2009.

Authors
Camacho, FT; Wu, J; Wei, W; Kimmick, G; Anderson, RT; Balkrishnan, R
MLA Citation
Camacho, FT, Wu, J, Wei, W, Kimmick, G, Anderson, RT, and Balkrishnan, R. "Cost impact of oral capecitabine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer." Journal of Medical Economics 12.3 (2009): 238-245.
PMID
19732030
Source
scival
Published In
Journal of Medical Economics
Volume
12
Issue
3
Publish Date
2009
Start Page
238
End Page
245
DOI
10.3111/13696990903269673

Newer antidepressants and gabapentin for hot flashes: An individual patient pooled analysis

Purpose: Nonhormonal treatment options have been investigated as treatments for hot flashes, a major clinical problem in many women. Starting in 2000, a series of 10 individual double-blind placebo-controlled studies has evaluated newer antidepressants and gabapentin for treating hot flashes. This current project was developed to conduct an individual patient pooled analysis of the data from these published clinical trials. Patients and Methods: Individual patient data were collected from the various study investigators who published their study results between 2000 and 2007. Between-study heterogeneity for study characteristics and patient populations was tested via χ2 tests before a pooled analysis. The primary end point, the change in hot flash activity from baseline to week 4, for each agent was calculated via both weighted and unweighted approaches, using the size of the study as the weight. Basic summary statistics were produced for hot flash score and frequency using the following three statistics: raw change, percent reduction, and whether or not a 50% reduction was achieved. Results: This study included seven trials of newer antidepressants and three trials of gabapentin. The optimal doses (defined by individual study results) of the newer antidepressants paroxetine, venlafaxine, fluoxetine, and sertraline decreased hot flash scores by 41%, 33%, 13%, and 3% to 18% compared with the corresponding placebo arms, respectively. The three gabapentin trials decreased hot flashes by 35% to 38% compared with the corresponding placebo arms. Conclusion: Some newer antidepressants and gabapentin, within 4 weeks of therapy initiation, decrease hot flashes more than placebo. Copyright © 2009 by American Society of Clinical Oncology. All rights reserved.

Authors
Loprinzi, CL; Sloan, J; Stearns, V; Slack, R; Iyengar, M; Diekmann, B; Kimmick, G; Lovato, J; Gordon, P; Pandya, K; Jr, TG; Barton, D; Novotny, P
MLA Citation
Loprinzi, CL, Sloan, J, Stearns, V, Slack, R, Iyengar, M, Diekmann, B, Kimmick, G, Lovato, J, Gordon, P, Pandya, K, Jr, TG, Barton, D, and Novotny, P. "Newer antidepressants and gabapentin for hot flashes: An individual patient pooled analysis." Journal of Clinical Oncology 27.17 (2009): 2831-2837.
PMID
19332723
Source
scival
Published In
Journal of Clinical Oncology
Volume
27
Issue
17
Publish Date
2009
Start Page
2831
End Page
2837
DOI
10.1200/JCO.2008.19.6253

Adjuvant hormonal therapy use among insured, low-income women with breast cancer

Purpose: Use of adjuvant hormonal therapy, which significantly decreases breast cancer mortality, has not been well described among poor women, who are at higher risk of cancer-related death. Here we explore use of adjuvant hormonal therapy in an insured, low-income population. Methods: A North Carolina Cancer Registry-Medicaid linked data set was used. Women with hormone receptor-positive or unknown, nonmetastatic breast cancer, diagnosed between 1998 and 2002, were included. Main outcomes were (1) prescription fill within 1 year of diagnosis, (2) adherence (medication possession ratio), and (3) persistence (absence of a 90-day gap in prescription fills over 12 months). Results: The population consisted of 1,491 women (mean age, 67 years). Sixty-four percent filled prescriptions. Predictors of prescription fill included the following: older age (odds ratio [OR], 1.01; P = .017), greater number of prescription medications (OR, 1.06; P = .001), nonmarried status (OR, 1.82; P = .001), higher stage (OR, 1.83; P < .001), positive hormone receptor status (positive v unknown, OR, 1.98; P < .001), not receiving adjuvant chemotherapy (OR, 1.74; P = .001), receipt of adjuvant radiation (OR, 1.55; P = .004), and treatment in a small hospital (OR, 1.49; P = .024). Adherence and persistence rates were 60% and 80%, respectively. Nonmarried status predicted greater adherence (OR, 1.90; P = .006) and persistence (OR, 1.75; P = .031). Conclusion: Prescription fill, adherence, and persistence to adjuvant hormonal therapy among socioeconomically disadvantaged women are low. Improving use of adjuvant hormonal therapy may lead to lower breast cancer-specific mortality in this population. © 2009 by American Society of Clinical Oncology.

Authors
Kimmick, G; Anderson, R; Camacho, F; Bhosle, M; Hwang, W; Balkrishnan, R
MLA Citation
Kimmick, G, Anderson, R, Camacho, F, Bhosle, M, Hwang, W, and Balkrishnan, R. "Adjuvant hormonal therapy use among insured, low-income women with breast cancer." Journal of Clinical Oncology 27.21 (2009): 3445-3451.
PMID
19451445
Source
scival
Published In
Journal of Clinical Oncology
Volume
27
Issue
21
Publish Date
2009
Start Page
3445
End Page
3451
DOI
10.1200/JCO.2008.19.2419

Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women.

OBJECTIVE: To describe patient and healthcare system correlates of receipt of recommended care in North Carolina (NC) as indicated by receipt of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS). STUDY DESIGN: Retrospective cohort study. METHODS: Subjects were 344 women diagnosed as having primary breast cancer in 1998 and 1999, who were classified as being alive at least 12 months after treatment with BCS. Medicaid claims were used to supplement central cancer registry (CCR) data about adjuvant RT, and hospital medical record verification was performed when no RT was documented. Health system characteristics (size and volume) were obtained from existing databases. RESULTS: Of 344 NC women enrolled in Medicaid and treated with BCS, one third did not receive RT. The following patient and health system characteristics were associated with lack of receipt of adjuvant RT after BCS: older age (>or=65 years), residing in a low-population density county, receiving BCS at a smaller hospital, and living in a county classified as a whole-county specialist scarcity area. CONCLUSIONS: Some low-income women do not access RT following BCS, placing them at risk for worse outcomes than those associated with standard mastectomy. We identify geographic isolation and scarcity of healthcare specialists as possible leverage points for interventions.

Authors
Anderson, RT; Kimmick, GG; Camacho, F; Whitmire, JT; Dickinson, C; Levine, EA; Torti, FM; Balkrishnan, R
MLA Citation
Anderson, RT, Kimmick, GG, Camacho, F, Whitmire, JT, Dickinson, C, Levine, EA, Torti, FM, and Balkrishnan, R. "Health system correlates of receipt of radiation therapy after breast-conserving surgery: a study of low-income Medicaid-enrolled women." Am J Manag Care 14.10 (October 2008): 644-652.
PMID
18837642
Source
pubmed
Published In
American Journal of Managed Care
Volume
14
Issue
10
Publish Date
2008
Start Page
644
End Page
652

Geriatric oncology: past, present, future.

Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.

Authors
Rao, AV; Hurria, A; Kimmick, G; Pinheiro, S; Seo, PH
MLA Citation
Rao, AV, Hurria, A, Kimmick, G, Pinheiro, S, and Seo, PH. "Geriatric oncology: past, present, future." J Oncol Pract 4.4 (July 2008): 190-192.
PMID
20856771
Source
pubmed
Published In
Journal of Oncology Practice
Volume
4
Issue
4
Publish Date
2008
Start Page
190
End Page
192
DOI
10.1200/JOP.0846001

BMI influences prognosis following surgery and adjuvant chemotherapy for lymph node positive breast cancer.

Increased body mass index (BMI) at diagnosis has been shown to be associated with an increased risk of disease recurrence and death. However, the association has not been consistent in the literature and may depend on several factors such as menopausal status, extent of disease, and receptor status. We performed a secondary analysis on what we believe is the largest prospective trial of adjuvant chemotherapy to assess the effect of BMI on prognosis in women with lymph node positive breast cancer. The study included 636 women with a median follow-up of over 13 years. Cox's proportional hazards regression model was used to assess the effect of BMI on outcomes. Kaplan-Meier methods were used to estimate survival curves and log rank tests were used to assess differences in survival for BMI groups. We found that increased BMI was generally predictive of faster time to recurrence and decreased survival, but that the relationship was stronger for younger women, those with progesterone receptor negative disease and those with a greater number of lymph nodes that were positive.

Authors
Vitolins, MZ; Kimmick, GG; Case, LD
MLA Citation
Vitolins, MZ, Kimmick, GG, and Case, LD. "BMI influences prognosis following surgery and adjuvant chemotherapy for lymph node positive breast cancer." Breast J 14.4 (July 2008): 357-365.
PMID
18540954
Source
pubmed
Published In
The Breast Journal
Volume
14
Issue
4
Publish Date
2008
Start Page
357
End Page
365
DOI
10.1111/j.1524-4741.2008.00598.x

A pilot study of predictive markers of chemotherapy-related amenorrhea among premenopausal women with early stage breast cancer.

BACKGROUND: Premenopausal women treated for early stage breast cancer (ESBC) are at risk for chemotherapy-related amenorrhea (CRA). Prospectively-validated, predictive markers of CRA are needed. PATIENTS AND METHODS: Premenopausal women with ESBC and planned chemotherapy (>/= 25% risk of amenorrhea) were evaluated. Follicle stimulating hormone (FSH), estradiol, Inhibin A and B, anti-Müllerian hormone (AMH), and quality of life (QOL) were prospectively evaluated pre-, post-, 6 months and 1 year post-chemotherapy and correlated with age and menstrual status. CRA was defined as absence of menses 1 year post-chemotherapy. RESULTS: Forty-four women were evaluated at the time of analysis. Median age at diagnosis and FSH 1 year post-chemotherapy were higher among women with CRA (44 yrs [33-51] vs. 40 yrs [31-43]; p = 0.03; 39.8 vs. 5.0 mLU/mL, p = 0.0058, respectively). Median estradiol 1 year post-chemotherapy was higher among women who resumed menses (108.3 vs. 41.3 pg/mL, p = 0.01). Pre-chemotherapy median Inhibin B and AMH were lower among women with CRA (33.2 vs. 108.8 pg/mL; p = 0.03; 0.16 vs. 1.09 ng/mL, p = 0.02, respectively). The risk of CRA was increased among women with lower pre-chemotherapy Inhibin B (RR = 1.67, p = 0.15) and AMH (RR = 1.83, p = 0.05). Amongst women whose pre-chemotherapy Inhibin B and AMH values were below the median, the incidence of CRA was 87.5%. CONCLUSIONS: RESULTS indicate that pre-chemotherapy Inhibin B and AMH are lower among women experiencing CRA and may be predictive of CRA among premenopausal women facing chemotherapy for ESBC.

Authors
Anders, C; Marcom, PK; Peterson, B; Gu, L; Unruhe, S; Welch, R; Lyons, P; Behera, M; Copland, S; Kimmick, G; Shaw, H; Snyder, S; Antenos, M; Woodruff, T; Blackwell, K
MLA Citation
Anders, C, Marcom, PK, Peterson, B, Gu, L, Unruhe, S, Welch, R, Lyons, P, Behera, M, Copland, S, Kimmick, G, Shaw, H, Snyder, S, Antenos, M, Woodruff, T, and Blackwell, K. "A pilot study of predictive markers of chemotherapy-related amenorrhea among premenopausal women with early stage breast cancer." Cancer Invest 26.3 (April 2008): 286-295.
PMID
18317970
Source
pubmed
Published In
Cancer Investigation (Informa)
Volume
26
Issue
3
Publish Date
2008
Start Page
286
End Page
295
DOI
10.1080/07357900701829777

A pilot study of predictive markers of chemotherapy-related amenorrhea among premenopausal women with early stage breast cancer (Cancer Investigation 26, 3, (286-295))

Authors
Anders, C; Marcom, PK; Peterson, B; Gu, L; Unruhe, S; Welch, R; Lyons, P; Behera, M; Copland, S; Kimmick, G; Shaw, H; Snyder, S; Antenos, M; Woodruff, T; Blackwell, K
MLA Citation
Anders, C, Marcom, PK, Peterson, B, Gu, L, Unruhe, S, Welch, R, Lyons, P, Behera, M, Copland, S, Kimmick, G, Shaw, H, Snyder, S, Antenos, M, Woodruff, T, and Blackwell, K. "A pilot study of predictive markers of chemotherapy-related amenorrhea among premenopausal women with early stage breast cancer (Cancer Investigation 26, 3, (286-295))." Cancer Investigation 26.10 (2008): 1068--.
Source
scival
Published In
Cancer Investigation (Informa)
Volume
26
Issue
10
Publish Date
2008
Start Page
1068-
DOI
10.1080/07357900802660220

Cognitive-behavioral intervention for hot flashes.

PURPOSE/OBJECTIVES: To pilot test the acceptability of a DVD platform to deliver a newly created cognitive-behavioral hot flash intervention and estimate the efficacy of the new intervention. DESIGN: Nonrandomized pretest, post-test design. SETTING: Midwestern and southeastern outpatient cancer clinics serving urban and rural areas. SAMPLE: 40 participants from two sites completed the study. METHODS: After completing preintervention assessments, participants watched a DVD of the intervention, practiced the intervention for one week, and then completed post-intervention assessments. Data were collected with a brief interview, questionnaires, objective hot flash monitoring, and wrist actigraphy. MAIN RESEARCH VARIABLES: Hot flash occurrence, severity, bother, mood disturbance, affect, hot flash disruption, and sleep disturbance. FINDINGS: The DVD was a feasible and acceptable method for intervention delivery. Although participants expressed difficulty in applying the intervention in certain situations, they also described benefits that included shorter hot flash duration (not measured in this study). Paired t tests showed significant but minor decreases in worst hot flash severity, worst hot flash bother, mood, and disruption of daily activities. CONCLUSIONS: The DVD was an acceptable way to deliver the intervention. However, the intervention will need to be improved before being tested in a larger study. IMPLICATIONS FOR NURSING: A cognitive-behavioral intervention may be a useful adjunct or alternative to current hot flash treatments. Findings will be used to modify the intervention and data collection methods before undertaking a larger study.

Authors
Carpenter, JS; Neal, JG; Payne, J; Kimmick, G; Storniolo, AM
MLA Citation
Carpenter, JS, Neal, JG, Payne, J, Kimmick, G, and Storniolo, AM. "Cognitive-behavioral intervention for hot flashes." Oncology nursing forum 34.1 (2007): 37--.
PMID
17562629
Source
scival
Published In
Oncology Nursing Forum
Volume
34
Issue
1
Publish Date
2007
Start Page
37-
DOI
10.1188/07.ONF.E1-E8

Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy

Background: Clinical studies indicate that breast cancer patients treated with breast conserving surgery (BCS) without radiotherapy (RT) have a greater risk of recurrence and mortality compared to those receiving BCS plus RT. However, this relationship has been underdeveloped among low-income women in the community who may face barriers in accessing adjuvant treatment and post-treatment surveillance. It is possible that the prognostic significance of omission of RT in clinical trials underestimates the significance of risk in the community. Methods: Using cancer registry, Medicaid claims, and the Social Security Master Death File, we evaluated receipt of RT in women with early stage breast cancer treated with BCS and mean 6-year overall and cancer-specific survival. Logistic regression was used to assess correlates of RT. The Kaplan-Meier method was used to determine survival by RT status and a multivariate Cox proportional hazards regression was used to evaluate the role of RT status on overall and cause-specific survival. Results: A total of 65% of women received RT, and 82% of the sample survived the study period. Death rates of 16% and 51% were observed among those who did and did not receive RT, respectively (P < 0.001). One-third of women who died from cancer (8 of 24) received radiation. Use of RT was associated with a statistically significant decrease in all-cause (hazard ratio = 0.42, 95% CI 0.21-0.85) and cancer-specific mortality (hazard ratio = 0.22, 95% CI -0.09 to 0.57). Conclusions: Adjuvant radiation following BCS was underused in this sample of poor breast cancer patients. Lack of adjuvant RT may be a proxy for inadequate access to care and poor cancer surveillance after treatment. © 2006 Springer Science+Business Media B.V.

Authors
Foley, KL; Kimmick, G; Camacho, F; Levine, EA; Balkrishnan, R; Anderson, R
MLA Citation
Foley, KL, Kimmick, G, Camacho, F, Levine, EA, Balkrishnan, R, and Anderson, R. "Survival disadvantage among Medicaid-insured breast cancer patients treated with breast conserving surgery without radiation therapy." Breast Cancer Research and Treatment 101.2 (2007): 207-214.
PMID
16838114
Source
scival
Published In
Breast Cancer Research and Treatment
Volume
101
Issue
2
Publish Date
2007
Start Page
207
End Page
214
DOI
10.1007/s10549-006-9280-2

Randomized, double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen.

We observed the relief of hot flashes in breast cancer survivors taking tamoxifen and treated with sertraline for depression. Our objective was to assess the effect of sertraline on the frequency and severity of hot flashes, mood status, and health-related quality of life. We used a randomized, double-blind, placebo-controlled, crossover study using 6 weeks of sertraline (50 mg each morning) versus placebo. Study participants were 62 breast cancer survivors from an oncology clinic in a tertiary care center on adjuvant tamoxifen reporting bothersome hot flashes. Patients were asked to keep a daily hot flash diary to record hot flash frequency and severity, from which hot flash scores (frequency x severity) were calculated. The Center for Epidemiologic Studies depression scale and Functional Assessment of Cancer Therapy--Breast (FACT-B) (at baseline, 6 weeks, and 12 weeks) were used to assess mood and quality of life. Sixty-two women were accrued. Forty-seven women (median age 53.9 years, range 36.6-77.1 years; 89% postmenopausal; 85.5% Caucasian) completed the first 6 weeks and 39 completed 12 weeks. The baseline daily hot flash frequency and score were 5.8 (standard deviation 4.1) and 11.5 (14.0), respectively. At the end of the first 6 weeks, hot flash frequency decreased by 50% in 36% of those taking sertraline compared to 27% taking placebo. In the crossover analysis, sertraline was significantly more effective than placebo: women crossing from placebo to sertraline had a decrease (-0.9 and -1.7) in hot flash frequency and score, whereas those crossing from sertraline to placebo had an increase (1.5 and 3.4) in hot flash frequency and score (p = 0.03 and 0.03). Forty-eight percent preferred the sertraline period, 11% preferred the placebo period, and 41% had no preference (p = 0.006). Measures of depression and quality of life were within normal range and did not change significantly within treatment groups. Sertraline decreases hot flashes in breast cancer survivors taking tamoxifen and women prefer sertraline to placebo. Further study of sertraline for the management of hot flashes is warranted.

Authors
Kimmick, GG; Lovato, J; McQuellon, R; Robinson, E; Muss, HB
MLA Citation
Kimmick, GG, Lovato, J, McQuellon, R, Robinson, E, and Muss, HB. "Randomized, double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen." Breast J 12.2 (March 2006): 114-122.
PMID
16509835
Source
pubmed
Published In
The Breast Journal
Volume
12
Issue
2
Publish Date
2006
Start Page
114
End Page
122
DOI
10.1111/j.1075-122X.2006.00218.x

Retrospective study of the effect of comorbidity on use of adjuvant chemotherapy in older women with breast cancer in a tertiary care setting

Use of adjuvant chemotherapy for breast cancer decreases with increasing age. We examined the effect of comorbidity on adjuvant chemotherapy use in older women (age >55 years) in a tertiary care Oncology Clinic. Clinic charts of new, early stage breast cancer patients over age 55 were reviewed. Multivariate analysis was used to determine the effect of age (55-64 versus ≥65 years), tumor stage, and comorbidity (Charlson score) on management. Two hundred and seventy-three charts were reviewed. Older women had a greater mean Charlson comorbidity score (0.72 versus 0.21; p < 0.001). Tamoxifen use was similar in both groups (82.8% versus 81.1%, p = 0.72). Chemotherapy was less frequently used in older women, regardless of nodal status: overall, 13.1% versus 45.6%, p < 0.001; node-negative, 8.2% versus 32.1%, p < 0.001; and node-positive, 25% versus 83.8%, p < 0.001. In a multivariate analysis, lower stage, older age, and higher comorbidity were predictive of less frequent use of adjuvant chemotherapy. Though higher comorbidity was associated with less use of adjuvant chemotherapy, it did not totally account for the low use of chemotherapy in older compared to younger women. More work should be planned to dissect out specific reasons for differences in treatment by age. © 2006 Elsevier Ireland Ltd. All rights reserved.

Authors
Hawfield, A; Lovato, J; Covington, D; Kimmick, G
MLA Citation
Hawfield, A, Lovato, J, Covington, D, and Kimmick, G. "Retrospective study of the effect of comorbidity on use of adjuvant chemotherapy in older women with breast cancer in a tertiary care setting." Critical Reviews in Oncology/Hematology 59.3 (2006): 250-255.
PMID
16527489
Source
scival
Published In
Critical Reviews in Oncology/Hematology
Volume
59
Issue
3
Publish Date
2006
Start Page
250
End Page
255
DOI
10.1016/j.critrevonc.2005.12.004

Response and cardiac toxicity of trastuzumab given in conjunction with weekly paclitaxel after doxorubicin/cyclophosphamide

Background: Adjuvant trastuzumab improves relapse-free survival in HER2-overexpressing breast cancer but is associated with cardiac toxicity. This phase II study was undertaken to determine the neoadjuvant clinical and pothologic response rate and the acute and chronic cardiac toxicity of trastuzumab given with weekly paclitaxel after AC (doxorubicin/cyclophosphamide). Patients and Methods: Fifty-two women with newly diodnosed, stage II-IV, HER2-overexpressing breast cancer received AC for 4 cycles, followed by weekly TP (paclitaxel/trastuzumab) for 12 weeks, neoadjuvantly or adjuvantly, followed by 40 weeks of adjuvant trastuzumab. Results: Congestive heart failure occurred in 4% of patients (95% confidence interval [Cl], 0.5%-13.2%). Asymptomatic left ventricular ejection fraction (LVEF) decreases to < 50% occurred in 21% of patients (95% Cl, 11.1%-34.7%); all but 1 recovered by 1.5 years. Median LVEF decreased progressively during therapy, from 65% before therapy (95% Cl, 63%-66%) to 62% after AC (95% Cl, 59%-64%) and 58% after AC-TP (95% Cl, 56%-64%; P < 0.01 for each decrease). The decrease in LVEF persisted 1.5 years after study entry at 57% (95% Cl, 54%-60%), although all but 1 of the most severe decreases to < 50% recovered to normal. Clinical response rate among 37 patients treated neoadjuvantly was 86%, and the pathologic complete response rate was 19% (95% Cl, 8%-35.2%). Because of withdrawals for toxicity, refractory disease, and patient preference, only 35% of patients completed the entire regimen. Conclusion: In this study, the AC-TP regimen resulted in a high clinical but moderate pothologic response rate, and although asymptomatic cardiac systolic dysfunction was common, most of the severe decreases recovered over time.

Authors
Kelly, H; Kimmick, G; Dees, C; Collichio, F; Gatti, L; Sawyer, L; Ivanova, A; Dressler, L; Graham, ML; Carey, LA
MLA Citation
Kelly, H, Kimmick, G, Dees, C, Collichio, F, Gatti, L, Sawyer, L, Ivanova, A, Dressler, L, Graham, ML, and Carey, LA. "Response and cardiac toxicity of trastuzumab given in conjunction with weekly paclitaxel after doxorubicin/cyclophosphamide." Clinical Breast Cancer 7.3 (2006): 237-243.
Source
scival
Published In
Clinical Breast Cancer
Volume
7
Issue
3
Publish Date
2006
Start Page
237
End Page
243

The Witherby/Muss article reviewed

Authors
Misra, D; Kimmick, GG
MLA Citation
Misra, D, and Kimmick, GG. "The Witherby/Muss article reviewed." ONCOLOGY 20.9 (2006): 1017-1018.
Source
scival
Published In
Oncology
Volume
20
Issue
9
Publish Date
2006
Start Page
1017
End Page
1018

The Extermann article reviewed

Authors
Anders, CK; Kimmick, G
MLA Citation
Anders, CK, and Kimmick, G. "The Extermann article reviewed." ONCOLOGY 20.11 (2006): 1360+1362-.
Source
scival
Published In
Oncology
Volume
20
Issue
11
Publish Date
2006
Start Page
1360+1362

Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001.

PURPOSE: To design and test a geriatric educational intervention to improve accrual of cancer patients age 65 years and older to cooperative group-sponsored treatment trials. METHODS: Main member institutions of the Cancer and Leukemia Group B (CALGB) and its affiliates were randomly assigned to receive standard information (n = 73) or educational intervention (n = 53). Standard information included CALGB Web site access and periodic notification about existing trials. The geriatric educational intervention included standard information plus: (1) an educational seminar; (2) educational materials; (3) a list of available protocols for use on charts; (4) a monthly e-mail and mail reminders for 1 year; and (5) a case discussion seminar. The main outcome was percentage of accrual of older persons to phase II and III treatment protocols after study initiation compared with baseline. RESULTS: There were 3,032 patients entered onto trials in the baseline year, and 2,160 and 1,239 during the 2 years postintervention, respectively. Overall percentage of accrual of older patients was 37% at baseline, and 33% and 31% during the first and second years after intervention. There was no improvement in accrual in the intervention versus control arm: 36% v 32% in the first year and 31% v 31% in the second year. CONCLUSION: Accrual of older patients was not increased by this intervention. Reasons for lack of effect include low intervention intensity, high baseline accrual rates, and closure of several high-accruing protocols during the study. More intense and multifaceted approaches will be needed to change physician (and patient) behavior and to increase accrual of older persons to clinical trials.

Authors
Kimmick, GG; Peterson, BL; Kornblith, AB; Mandelblatt, J; Johnson, JL; Wheeler, J; Heinze, R; Cohen, HJ; Muss, HB
MLA Citation
Kimmick, GG, Peterson, BL, Kornblith, AB, Mandelblatt, J, Johnson, JL, Wheeler, J, Heinze, R, Cohen, HJ, and Muss, HB. "Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001." J Clin Oncol 23.10 (April 1, 2005): 2201-2207.
PMID
15800312
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
23
Issue
10
Publish Date
2005
Start Page
2201
End Page
2207
DOI
10.1200/JCO.2005.01.222

In reply [10]

Authors
Kimmick, GG; Peterson, BL; Kornblith, AB; Mandelblatt, J; Johnson, JL; Wheeler, J; Heinze, R; Cohen, HJ; Muss, HB
MLA Citation
Kimmick, GG, Peterson, BL, Kornblith, AB, Mandelblatt, J, Johnson, JL, Wheeler, J, Heinze, R, Cohen, HJ, and Muss, HB. "In reply [10]." Journal of Clinical Oncology 23.30 (2005): 7752-7753.
Source
scival
Published In
Journal of Clinical Oncology
Volume
23
Issue
30
Publish Date
2005
Start Page
7752
End Page
7753
DOI
10.1200/JCO.2005.02.8787

Breast cancer in older patients.

Breast cancer is a common problem and a major health concern in our growing geriatric population. Older breast cancer patients are at risk for less than standard management, the appropriateness of which is difficult to discern. Breast tumors tend to have less aggressive characteristics. In addition, planning therapy is not always straightforward because older patients may present with comorbid illnesses and frailty that limit therapeutic choices. Standard management approaches should always be considered first. Here, we outline some data supporting standard treatment for breast cancer in older women. We also describe other options that can be considered in circumstances when the standard treatment is not possible. For instance, primary treatment with tamoxifen or an aromatase inhibitor is justifiable in a patient who is unfit for surgery and axillary dissection may be unnecessary in a patient who is obviously unfit for adjuvant chemotherapy. Adjuvant therapies should be considered, weighing risks and benefits for each patient, though the threshold for using chemotherapy may be higher. The goals in treating metastatic breast cancer in an older patient are not different than for younger patients.

Authors
Kimmick, G; Muss, HB
MLA Citation
Kimmick, G, and Muss, HB. "Breast cancer in older patients." Semin Oncol 31.2 (April 2004): 234-248. (Review)
PMID
15112153
Source
pubmed
Published In
Seminars in Oncology
Volume
31
Issue
2
Publish Date
2004
Start Page
234
End Page
248

Subcutaneously administered recombinant human interleukin-2 and interferon alfa-2a for advanced breast cancer: a phase II study of the Cancer and Leukemia Group B (CALGB 9041).

New and more effective treatments are needed for metastatic breast cancer. This study aimed to determine the effectiveness of a combination of subcutaneously administered recombinant human interleukin-2 (rIL-2), 1.5 MU/m(2) for 5 consecutive days repeated for 3 weeks, and interferon alpha-2a (IFN), 7.5 MU/m(2), administered subcutaneously three times per week. Women who had previously received 1-2 prior chemotherapy regimens for measurable inoperable, recurrent, or metastatic breast cancer were eligible. Of 40 patients accrued to the study, 32 were evaluable for response assessment. Toxicities were frequent but manageable. The most common grade 3 and 4 toxicities were lymphopenia (17%) and malaise/fatigue (24%). There were no complete responses, one partial response (3%), and six patients with stable disease (19%). Of the seven patients with partial response or stable disease, all had tumors that expressed hormone receptors. The median survival was 8.9 months and all patients have died. Good performance status was the most important predictor of survival. In this group of women with metastatic breast cancer, the overall prognosis was poor. This combination of rIL-2 and IFN was ineffective.

Authors
Kimmick, G; Ratain, MJ; Berry, D; Woolf, S; Norton, L; Muss, HB; Cancer and Leukemia Group B (CALGB 9041),
MLA Citation
Kimmick, G, Ratain, MJ, Berry, D, Woolf, S, Norton, L, Muss, HB, and Cancer and Leukemia Group B (CALGB 9041), . "Subcutaneously administered recombinant human interleukin-2 and interferon alfa-2a for advanced breast cancer: a phase II study of the Cancer and Leukemia Group B (CALGB 9041)." Invest New Drugs 22.1 (January 2004): 83-89.
PMID
14707498
Source
pubmed
Published In
Investigational New Drugs
Volume
22
Issue
1
Publish Date
2004
Start Page
83
End Page
89

Long-term follow-up of a phase II trial studying a weekly doxorubicin-based multiple drug adjuvant therapy for stage II node-positive carcinoma of the breast.

BACKGROUND: Combination chemotherapy improves outcomes in women with breast cancer (BC) that involves axillary nodes. This single-arm study aimed to evaluate the effectiveness of an intensive doxorubicin-based multidrug regimen as adjuvant therapy in women with stage II, node positive breast cancer. PATIENTS AND METHODS: Between 7/80 and 8/85, 654 women, aged 25-73, who had a mastectomy for stage IIB BC were accrued. Patients with prior RT, chemotherapy, or surgical or radiation castration within 1 year of diagnosis were excluded. Treatment consisted of: 6 weekly courses of IV cyclophosphamide (C) 400 mg/m2, doxorubicin (A) 10 mg/m2, vincristine (V) I mg/m2, fluorouracil (F) 400 mg/m2, and a tapering course of prednisone followed by 12 courses of C 400 mg/m2, A 20mg/m2, V 1 mg/m2, F 400 mg/m2 given every 2 weeks. Patients with estrogen receptor positive tumors received Tamoxifen 10 mg bid between weeks 8 and 30. Treatment did not exceed 8 months. Median follow-up is 13.1 years. RESULTS: Six hundred thirty six patients are eligible. Fewer positive (+) nodes, premenopausal status, and positive progesterone receptor status are significantly (p < 0.05) associated with longer survival. At 10 years, 61% were relapse-free in the 1-3 +node group compared to 37 and 21% in the 4-9 and > or = 10 +node groups, respectively (p = 0.0001). Relapse-free survival at 10 years is 50% for premenopausal and 45% for postmenopausal patients. Severe or life-threatening hematological toxicity was seen in 6/630 (< 1%) patients. Four patients had severe (grade 3) neurotoxicity which resolved. No cardiac toxicity was observed. CONCLUSION: This adjuvant regimen compares favorably to other published adjuvant treatments with similar length of follow-up.

Authors
Kimmick, GG; Shelton, BJ; Case, LD; Cooper, MR; Muss, HB
MLA Citation
Kimmick, GG, Shelton, BJ, Case, LD, Cooper, MR, and Muss, HB. "Long-term follow-up of a phase II trial studying a weekly doxorubicin-based multiple drug adjuvant therapy for stage II node-positive carcinoma of the breast." Breast Cancer Res Treat 72.3 (April 2002): 233-243.
PMID
12058965
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
72
Issue
3
Publish Date
2002
Start Page
233
End Page
243

Interpreting measures of treatment effect in cancer clinical trials.

The efficacy of a new cancer regimen is usually assessed by analyzing outcomes such as tumor response and overall survival. Many publications summarizing results of cancer clinical trials report measures such as odds ratios and hazard ratios, as these are the estimators of treatment effect obtained from regression models used to analyze the data. However, these measures are sometimes misinterpreted, as they are not necessarily familiar to many readers. The most common mistake is to interpret both measures as relative risks, an interpretation that can lead to an incorrect impression of the impact of the treatment on response and survival.

Authors
Case, LD; Kimmick, G; Paskett, ED; Lohman, K; Tucker, R
MLA Citation
Case, LD, Kimmick, G, Paskett, ED, Lohman, K, and Tucker, R. "Interpreting measures of treatment effect in cancer clinical trials." Oncologist 7.3 (2002): 181-187.
PMID
12065789
Source
pubmed
Published In
The oncologist
Volume
7
Issue
3
Publish Date
2002
Start Page
181
End Page
187

Systemic therapy for older women with breast cancer.

Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient's wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols.

Authors
Kimmick, GG; Muss, HB
MLA Citation
Kimmick, GG, and Muss, HB. "Systemic therapy for older women with breast cancer." Oncology (Williston Park) 15.3 (March 2001): 280-291. (Review)
PMID
11301828
Source
pubmed
Published In
Oncology
Volume
15
Issue
3
Publish Date
2001
Start Page
280
End Page
291

Breast cancer and aging. Clinical interactions.

The incidence and mortality rates of breast cancer increase with age. As the geriatric population grows, the number of breast cancer cases will reach epidemic proportions. The number of coexisting medical conditions also increases with advancing age. The presence and severity of comorbid conditions influences an individual's ability to tolerate procedures and treatments and must be considered in making disease-management decisions. Screening mammography can potentially save lives in older women. Women whose life expectancy exceeds 5 years should continue annual screening mammography. Choices for local definitive therapy, systemic adjuvant therapy, and treatment of metastatic disease should be based on patient preference and ability to tolerate the planned procedure. In general, otherwise healthy older women should be offered the same treatment options given to younger, postmenopausal women. Alternative, less aggressive, or nonstandard approaches are warranted in women whose life expectancy is limited or who are unable or unwilling to undergo standard management procedures.

Authors
Kimmick, GG; Balducci, L
MLA Citation
Kimmick, GG, and Balducci, L. "Breast cancer and aging. Clinical interactions." Hematol Oncol Clin North Am 14.1 (February 2000): 213-234. (Review)
PMID
10680079
Source
pubmed
Published In
Hematology/Oncology Clinics of North America
Volume
14
Issue
1
Publish Date
2000
Start Page
213
End Page
234

Endocrine therapy in metastatic breast cancer.

Endocrine therapy represents a mainstay of effective, minimally toxic, palliative treatment for metastatic breast cancer. Research focusing on the mechanism of action of endocrine agents will provide new insights leading to new hormonal approaches in breast cancer treatment. Development of new agents, especially the 'pure' antiestrogens, is of great interest. Combining endocrine therapy with biologic agents, especially antiproliferative compounds, may lead to more effective treatment in the adjuvant as well as the advanced setting. Tables 4 and 5 summarize response rates to the different groups of endocrine agents used in metastatic breast cancer and doses of commonly used agents, respectively. At present, tamoxifen is the drug of choice as first-line endocrine therapy for metastatic breast cancer with no or minimal symptoms in premenopausal or postmenopausal women. Second-line therapy usually consists of megace. Aromatase inhibitors may be used as second- or third-line therapy in postmenopausal women. In premenopausal women, LHRH analogues are a reasonable choice. The other hormonal agents may be beneficial as salvage therapy. More effective endocrine approaches are under development.

Authors
Kimmick, GG; Muss, HB
MLA Citation
Kimmick, GG, and Muss, HB. "Endocrine therapy in metastatic breast cancer." Cancer Treat Res 94 (1998): 231-254. (Review)
PMID
9587691
Source
pubmed
Published In
Cancer Treatment and Research
Volume
94
Publish Date
1998
Start Page
231
End Page
254

Generalized cutaneous metastases from breast adenocarcinoma.

Authors
Gade, JN; Kimmick, G; Hitchcock, MG; McMichael, AJ
MLA Citation
Gade, JN, Kimmick, G, Hitchcock, MG, and McMichael, AJ. "Generalized cutaneous metastases from breast adenocarcinoma." J Am Acad Dermatol 37.1 (July 1997): 129-130.
PMID
9216540
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
37
Issue
1
Publish Date
1997
Start Page
129
End Page
130

Breast cancer in older women

Breast cancer in older women is a major national health concern. Over 50% of breast cancers are diagnosed in women older than age 65, a quickly growing segment of our population. Healthy older women should be offered 'state of the art' screening and treatment for breast cancer. This includes mammography, surgery, radiation therapy, and adjuvant therapy for early stage tumors. Clinical trials focusing on the role of adjuvant treatment in older women with breast cancer are of paramount importance. In older women with other comorbid conditions that may limit survival or jeopardize surgical outcomes, primary treatment with tamoxifen or adjuvant therapy with tamoxifen alone after surgery may be warranted. Outside of the clinical trials setting, metastatic disease should be treated similarly in all age groups.

Authors
Kimmick, G; Muss, HB
MLA Citation
Kimmick, G, and Muss, HB. "Breast cancer in older women." Clinics in Geriatric Medicine 13.2 (May 24, 1997): 265-282. (Review)
Source
scopus
Published In
Clinics in Geriatric Medicine
Volume
13
Issue
2
Publish Date
1997
Start Page
265
End Page
282

Breast cancer in older women.

More than 50% of breast cancers are diagnosed in women aged 65 years or older, a quickly growing segment of the population. Healthy older women should be offered state-of-the-art screening and treatment for breast cancer, including mammography, surgery, radiation therapy, and adjuvant therapy for early stage tumors. Clinical trials focusing on the role of adjuvant treatment in older women with breast cancer are of chief importance. The optimal treatment for older women with life-threatening, comorbid conditions may be primary treatment with tamoxifen or adjuvant therapy with tamoxifen alone after definitive surgery. Outside the clinical trials setting, metastatic disease should be treated similarly in all age groups.

Authors
Kimmick, G; Muss, HB
MLA Citation
Kimmick, G, and Muss, HB. "Breast cancer in older women." Clin Geriatr Med 13.2 (May 1997): 265-282. (Review)
PMID
9115451
Source
pubmed
Published In
Clinics in Geriatric Medicine
Volume
13
Issue
2
Publish Date
1997
Start Page
265
End Page
282

Cancer chemotherapy in older adults. A tolerability perspective.

The incidence of cancer increases with age. Since the geriatric population is growing, we will be confronted with an increasing number of patients with cancer who are > 65 years of age. The purpose of this review is to address the use of cancer chemotherapy in older persons with respect to its tolerability. We performed a review of the literature using 'Medline' and the bibliographies of pertinent publications. Information about cancer treatment in older adults was extracted with particular attention to chemotherapy-related toxicity in patients aged > 65 years. Comorbid disease, polypharmacy/drug interactions, psychosocial issues and age-related physiological changes are major issues in caring for older patients with cancer. Since older individuals may have a greater number of comorbid illnesses, treatment should be initiated on the basis of physiological rather than chronological age. Comparative studies show that chemotherapy-related toxicity is similar in older and younger patients, with the exception of haematological toxicity, which may be more severe in older patients, and cardiotoxicity, which is more frequent in the elderly. Other evidence suggests that gastrointestinal and neurotoxicities may also be more severe in older individuals. The dosages of chemotherapeutic agents that are primarily renally excreted may require adjustment in older patients. Haematological reserve is decrease in older individuals, and drugs that cause myelosuppression must be used with care. The use of haemopoietic growth factors in geriatric patients is currently being investigated.

Authors
Kimmick, GG; Fleming, R; Muss, HB; Balducci, L
MLA Citation
Kimmick, GG, Fleming, R, Muss, HB, and Balducci, L. "Cancer chemotherapy in older adults. A tolerability perspective." Drugs Aging 10.1 (January 1997): 34-49. (Review)
PMID
9111706
Source
pubmed
Published In
Drugs & aging
Volume
10
Issue
1
Publish Date
1997
Start Page
34
End Page
49

Vitamin E and breast cancer: a review.

Breast cancer is a major health problem in America, accounting for almost one-third of cancer-related deaths in women. The prevention of breast cancer through dietary modification is an active area of clinical and epidemiologic research. It has been proposed that the dietary supplementation of vitamin E, a lipid-soluble antioxidant, may reduce a woman's risk of developing breast cancer. In animal models, vitamin E has decreased the incidence of carcinogen-induced mammary tumors. Intake and serum levels of vitamin E and their relation to breast cancer have been evaluated in epidemiologic studies. Results of epidemiologic studies, however, have been conflicting. In this review, we examine the evidence that is available pertaining to the relationship between vitamin E and breast cancer. Although epidemiologic study results have been inconsistent, further study of this nontoxic vitamin is warranted. Particular attention should be paid to the interactions of other antioxidants with vitamin E and to the duration and timing (pre- vs. postmenopausal) of vitamin E use in determining its preventive utility in breast cancer.

Authors
Kimmick, GG; Bell, RA; Bostick, RM
MLA Citation
Kimmick, GG, Bell, RA, and Bostick, RM. "Vitamin E and breast cancer: a review." Nutr Cancer 27.2 (1997): 109-117. (Review)
PMID
9121936
Source
pubmed
Published In
Nutrition and Cancer
Volume
27
Issue
2
Publish Date
1997
Start Page
109
End Page
117
DOI
10.1080/01635589709514511

Quality-of-life measurement in women with breast cancer

The health-related quality of life (QOL) of breast cancer patients has been the focus of study for many years. However, it is only recently that the quality-of-life construct has been precisely defined and measured with validated, reliable instruments. The measurement of health-related quality of life and the application of this data in clinical practice has been facilitated by the publication of several QOL instruments widely used in clinical trials. Knowledge of available instruments and a growing database on quality of life following treatment for breast cancer allows clinicians and patients to better collaborate to improve patient functioning following treatment. The task for practitioners is to translate current QOL data into useful information for patients.

Authors
McQuellon, RP; Kimmick, G; Hurt, GJ
MLA Citation
McQuellon, RP, Kimmick, G, and Hurt, GJ. "Quality-of-life measurement in women with breast cancer." Breast Journal 3.4 (1997): 178-186.
Source
scival
Published In
The Breast Journal
Volume
3
Issue
4
Publish Date
1997
Start Page
178
End Page
186
DOI
10.1111/j.1524-4741.1997.tb00163.x

Rhabdomyolysis and hemolysis associated with sickle cell trait and glucose-6-phosphate dehydrogenase deficiency.

We report a case of severe oxidative hemolysis and rhabdomyolysis in a patient with sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient was a 34-year-old black man admitted 24 hours after vigorous exercise with myalgias, malaise, myoglobinuria, anemia, low haptoglobin, and a peripheral blood smear with bite cells consistent with oxidative hemolysis. He had two similar episodes within 21 months of the initial admission. Subsequent evaluation resulted in the diagnosis of sickle cell trait and G6PD deficiency; muscle enzyme levels were normal. G6PD deficiency and sickle cell trait can be expected to occur simultaneously in up to 1% of black males. A second red blood cell defect should be considered when severe hemolysis is seen in a person with sickle cell trait.

Authors
Kimmick, G; Owen, J
MLA Citation
Kimmick, G, and Owen, J. "Rhabdomyolysis and hemolysis associated with sickle cell trait and glucose-6-phosphate dehydrogenase deficiency." South Med J 89.11 (November 1996): 1097-1098.
PMID
8903296
Source
pubmed
Published In
Southern Medical Journal
Volume
89
Issue
11
Publish Date
1996
Start Page
1097
End Page
1098

Tamoxifen in postmenopausal women a safety perspective.

Tamoxifen is a synthetic antiestrogen with both agonist and antagonist properties. It is believed to act primarily through binding to estrogen receptors in breast cancer cells, acting as a competitive inhibitor of estrogen. Tamoxifen has a wide range of systemic effects, possibly acting on every estrogen target tissue in the body. Tamoxifen therapy is associated with a significant reduction in the risk of recurrence and death in postmenopausal women with early stage breast cancer. In addition, it has been shown to effectively suppress preclinical breast cancer, as evidenced by the decrease in second primary breast cancers in adjuvant trials. Tamoxifen is also the most widely used endocrine therapy for women with metastatic breast cancer. Tamoxifen, acting predominantly as an estrogen agonist in the liver, has generally favourable effects on serum lipids in postmenopausal women. In addition, tamoxifen has been shown to preserve bone mineral density and may even decrease the risk of osteoporosis in these women. Most patients treated with tamoxifen have minimal adverse effects. Vasomotor symptoms are the most commonly reported events. Less frequently, vaginal discharge or dryness, nausea and depression have been reported. A slight increase in thromboembolic events in postmenopausal women taking tamoxifen has been suggested in some adjuvant trials. Rarely, ocular toxicity and hepatotoxicity are found. The adverse effect of primary importance is the increased incidence of endometrial carcinoma. Several studies indicate that almost all of the tumours are of low histological grade and stage, similar to those seen with exogenous estrogen use. The relative risk of endometrial cancer in women taking tamoxifen is about 2 to 4 times higher than for postmenopausal women not taking tamoxifen. The benefits of tamoxifen outweigh the risks in almost all postmenopausal women with estrogen receptor-positive early stage breast cancer and in all women with metastatic breast cancer. Should tamoxifen prove to be an effective chemopreventive agent for breast cancer, the risks and benefits of treatment will have to be more carefully assessed for this setting.

Authors
Robinson, E; Kimmick, GG; Muss, HB
MLA Citation
Robinson, E, Kimmick, GG, and Muss, HB. "Tamoxifen in postmenopausal women a safety perspective." Drugs Aging 8.5 (May 1996): 329-337. (Review)
PMID
8935395
Source
pubmed
Published In
Drugs & aging
Volume
8
Issue
5
Publish Date
1996
Start Page
329
End Page
337

Current status of endocrine therapy for metastatic breast cancer.

Hormonal manipulation is currently the mainstay of palliative care for metastatic breast cancer because it is well tolerated and produces significant responses in approximately one-third of unselected patients. Tamoxifen, a nonsteroidal antiestrogen, is currently considered first-line therapy. Second-line agents include progestins and aromatase inhibitors. New agents, such as the "pure" antiestrogens and the gonadotropin-releasing hormone (GnRH) agonists, are being tested. Other approaches for affecting the hormonal milieu are also under investigation, including combinations of hormonal agents, hormonal agents plus biologics, and hormonal agents plus antiproliferative agents. This review will address the basis for endocrine therapy and possible mechanisms of hormonal resistance, currently available agents and newer ones on the horizon, and areas of future interest.

Authors
Kimmick, G; Muss, HB
MLA Citation
Kimmick, G, and Muss, HB. "Current status of endocrine therapy for metastatic breast cancer." Oncology (Williston Park) 9.9 (September 1995): 877-890. (Review)
PMID
8562327
Source
pubmed
Published In
Oncology
Volume
9
Issue
9
Publish Date
1995
Start Page
877
End Page
890

Breast cancer in older women

Authors
Kimmick, G; Muss, HB
MLA Citation
Kimmick, G, and Muss, HB. "Breast cancer in older women." Breast Journal 1.5 (1995): 300-307.
Source
scival
Published In
Breast Journal
Volume
1
Issue
5
Publish Date
1995
Start Page
300
End Page
307

A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The Piedmont Oncology Association experience.

Prior studies have shown that black patients with breast cancer have poorer survival times compared with white patients even when adjusted for stage. Seventy-four black patients treated on six Piedmont Oncology Association (POA) protocols were compared with 74 randomly selected white patients treated with the same protocols to determine if race had any independent effect on response, time to progression, or survival time. Patients were evenly matched for pretreatment characteristics with the exception that white patients had a significantly higher percentage of bone metastases and significantly less skin involvement. Response rates and median time to progression were similar for black patients and white patients at 31% and 25%, and 9.3 and 9.1 months, respectively. Black patients had poorer survival times even when adjusting for covariables; median survival time was 14.3 months for black patients and 20.3 months for white patients (P less than 0.05). The reason for this survival difference in Stage IV patients is unclear, but is unlikely to be related to treatment. Additional research in this area will be necessary to resolve this issue.

Authors
Kimmick, G; Muss, HB; Case, LD; Stanley, V
MLA Citation
Kimmick, G, Muss, HB, Case, LD, and Stanley, V. "A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The Piedmont Oncology Association experience." Cancer 67.11 (June 1, 1991): 2850-2854.
PMID
2025850
Source
pubmed
Published In
Cancer
Volume
67
Issue
11
Publish Date
1991
Start Page
2850
End Page
2854

A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The piedmont oncology association experience

Prior studies have shown that black patients with breast cancer have poorer survival times compared with white patients even when adjusted for stage. Seventy‐four black patients treated on six Piedmont Oncology Association (POA) protocols were compared with 74 randomly selected white patients treated with the same protocols to determine if race had any independent effect on response, time to progression, or survival time. Patients were evenly matched for pretreatment characteristics with the exception that white patients had a significantly higher percentage of bone metastases and significantly less skin involvement. Response rates and median time to progression were similar for black patients and white patients at 31% and 25%, and 9.3 and 9.1 months, respectively. Black patients had poorer survival times even when adjusting for covariables; median survival time was 14.3 months for black patients and 20.3 months for white patients (P less than 0.05). The reason for this survival difference in Stage IV patients is unclear, but is unlikely to be related to treatment. Additional research in this area will be necessary to resolve this issue. Copyright © 1991 American Cancer Society

Authors
Kimmick, G; Muss, HB; Douglas Case, L; Stanley, V
MLA Citation
Kimmick, G, Muss, HB, Douglas Case, L, and Stanley, V. "A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The piedmont oncology association experience." Cancer 67.11 (January 1, 1991): 2850-2854.
Source
scopus
Published In
Cancer
Volume
67
Issue
11
Publish Date
1991
Start Page
2850
End Page
2854
DOI
10.1002/1097-0142(19910601)67:11<2850::AID-CNCR2820671124>3.0.CO;2-S
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