Annual Meeting Proceedings Part 1 - American Society of Clinical ...

106s Cancer Prevention/Epidemiology
1584 General Poster Session (Board #7B), Sat, 1:15 PM-5:15 PM
Impact of response shift on time to quality-of-life scores deterioration in
patients with breast cancer. Presenting Author: Zeinab Hamidou, Biostatistics
and Epidemiology Unit, Medical Information Department, Centre
Georges-François Leclerc and EA4184, College of Medicine, Dijon, France
Background: Time to quality of life (QoL) score deterioration (TD) is a
method of longitudinal QoL data analysis that has been proposed for breast
cancer (BC) patients (Hamidou et al Oncologist 2011). As for RECIST
criteria, the optimal definitions dealing with reference should be explored.
This study aims to study the impact of changes in internal standards (CIS)
of response-shift (RS) and the influence of baseline QoL expectancies on
TD. Methods: A prospective multicenter study including all women hospitalized
for a primary BC was conducted. The EORTC-QLQ-C30 and BR-23
questionnaires were used to assess the QoL at baseline, at the end of 1st hospitalization, and 3 and 6 months after. CIS was investigated by the
then-test method. QoL expectancy was assessed at baseline using Likert
scale. Deterioration was defined as a decrease in QoL scores reaching at
least the mean difference identified as minimal clinically important
difference (MCID) using Jaeschke’s transition question. Sensitivity analyses
were done using the then-test score as reference score, and considering
5 and 10 points as MCID. TD was estimated using Kaplan-Meier method.
Cox regression analyses were used to identify factors influencing TD.
Results: From February 2006 to February 2008, 381 women were included.
For role functioning dimension, the median TD increased from 3.2
months [95% CI: 3.1-3.36] to 4.76 months [3.3-6.2] when adjusting on
CIS. For body image when adjusting on CIS, sentinel lymph node biopsy
became significantly associated with longer TD (HR: 0.64[0.43-0.94]) as
compared to axillary lymph node dissection, radiotherapy to a shorter TD
(HR: 0.63[0.42-0.95] and the type of surgery had no effect on TD. For
global health, cognitive and social functioning dimensions, patients expecting
deterioration in their QoL had a significantly shorter TD. For fatigue and
breast symptom scales, patients expecting no change had a significantly
shorter TD, as compared to patients expecting an improvement. Sensitivity
analyses using a MDCS of 5 or 10 confirmed these results. Conclusions: Our
results suggest that it would be more accurate to take into account CIS
component of RS as well as QoL expectancies to estimate TD of QoL scores
in patient with BC.
1586 General Poster Session (Board #7D), Sat, 1:15 PM-5:15 PM
Outcomes of male breast cancer in the United States: A SEER database
analysis from 1973 to 2008. Presenting Author: Akm Mosharraf Hossain,
Ellis Fischel Cancer Center, Missouri University School of Medicine,
Columbia, MO
Background: Male breast cancer (MBC) is rare compared to female breast
cancer (FBC). There has been no systemic study to examine the epidemiology
of MBC in USA in the past decade. Methods: We examined 6,157 cases
of MBC reported in SEER database from 1973-2008 (released 2011). We
performed rate, frequency and survival sessions to examine age, sex, stage,
grade, treatment modalities and survival using the SEER*Stat Software
7.0.5. These variables were compared with that of 877,885 FBC cases
reported in SEER 1973-2008. Results: The incidence rate was 1.3 (MBC)
and 124 (FBC) per 100,000, respectively. Median age of diagnosis was
higher in MBC compared to FBC (72 vs. 61 yrs. P�0.001). 18% of MBC
were seen at age less than 60 years compared to 32% in FBC (p�0.001).
FBC tend to be more hormone receptor positive (74% vs. 61%; p�0.001).
There were 5,145 Caucasians (WH), 701 African Americans (AA), 258
Hispanics and 42 Asian patients. Stage III and IV, Grade III and IV
histologies were more common in MBC. Staging and Grading did not differ
among the different ethnicities except for Grade IV histology in AA 19%,
Asians 20% when compared to WH 13% (p�0.001). Treatment modalities
included, surgery (MBC 78% vs. FBC 93%; p�0.001), chemotherapy
(MBC 82% vs. FBC 43%; p�0.001) and radiation therapy (MBC 19% vs.
36% FBC; p�0.001). Treatment modalities were similar among WH and
AA. Survival was higher in FBC compared to MBC (table) but improved over
time in MBC. AA and Asians had lower 1-5 year survival compared to WH.
Conclusions: MBC presents at a later age, higher stage and grade,
predominantly requiring chemotherapy with an overall poor survival compared
to FBC. But 1-5 year survival improved over time in MBC. This can be
explained by early diagnosis, better treatment and other factors. Further
studies should be performed in this regard.
Comparison of survival between male and female breast cancer patients
reported in SEER database from 1973 to 2008.
Variable Male (N�6,157) Female (N�877,885) p value
1 year (%) 91.3 (91.6 – 93) 96.1 � 0.001
2 years (%) 85.9 (84.9 – 86.9) 90.1 � 0.001
3 years (%) 79.9 (78.7 – 81.1) 85.1 � 0.001
4 years (%) 73.5 (72.2 – 74.8) 80.7 � 0.001
5 years (%) 67.9 (66.6 – 69.3) 76.7 � 0.001
1585 General Poster Session (Board #7C), Sat, 1:15 PM-5:15 PM
An exploratory study to determine if BRCA1 and BRCA2 mutation carriers
have higher risk of cardiac toxicity. Presenting Author: Roohi Ismail-Khan,
H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
Background: Anthracycline related cardiac toxicity (CT) is a concern in
treating women with breast cancer. The prevalence of heart failure (HF)
affects 2% of the population, less so in women. Patients receiving
anthracycline based therapy (ABT) have a dose-dependent risk of reduction
in ejection fraction. Recent work by Dr. Verma suggests that BRCAdeficient
mice manifest increased levels of cardiac failure. We sought to
explore the risk for CT and evaluate the association between ABT and HF in
female BRCA mutation carriers. Methods: An online survey was developed
to collect information about breast cancer treatment (including HF) in
BRCA mutation carriers through the national BRCA patient advocacy
organization FORCE via their 2011 conference and their website as well as
the Moffitt-based Inherited Cancer Registry (ICARE). The prevalence of CT
and HF was calculated in both BRCA 1 and 2 breast cancer patients and
compared to general population risks. Data from those that received ABT
was compared to published HF rates from ABT. Results: Our sample
included 227 BRCA1 carriers and 164 BRCA2 carriers in whom 6.4%
reported cardiac toxicity (i.e., either HF and/or CT). This included similar
proportions in BRCA1 vs BRCA2 carriers (i.e., 6.6% and 6.1%, respectively).
These proportions are significantly higher than the published rate of
2% (all p-values � 0.001). Specifically regarding ABT, 112 mutation
carriers had doxorubicin (Adriamycin) for treatment of whom 8% reported
HF, similar to the 11 who had Epirubicin (11 patients), of whom 9%
reported HF. Conclusions: Our data suggests that BRCA mutation carriers
may have an increased risk of CT compared to the general population. In
particular, women with BRCA mutations treated with ABT also appear to
have a higher risk of developing CT and/or HF. This exploratory study
provides the basis upon which larger retrospective and prospective studies
are currently being planned. The high percentage of CT observed in this
study requires confirmation as they could inform recommendation for
cardiac screening and review of the current standard for ABT use in this
population.
1587 General Poster Session (Board #7E), Sat, 1:15 PM-5:15 PM
Evaluation of perioperative therapy for stage II and III rectal cancer in
California, 1994-2009. Presenting Author: Myung Mi Cho, Loma Linda
University School of Public Health, Department of Epidemiology and
Biostatistics, Loma Linda, CA
Background: Surgical treatment of stage II and III rectal cancer changed
little during the past two decades, while ancillary therapies have undergone
two evolutionary changes. We sought to evaluate changes in chemoradiation
(chemoRT) practices for patients receiving radical operations for stage
II and III rectal cancer in California, 1994-2009. Methods: We extracted
age, sex, race/ethnicity (R/E), socioeconomic status (SES) (demographic
variables) and chemoRT variables for stage II and III rectal cancer cases in
California. We used unconditional logistic regression to compute independent
odds ratios of receiving preoperative chemoRT (PreOP Tx) to postoperative
chemoRT (PostOP Tx) during Early (1994-1999), Middle (2000-
2003), and Late (2004-2009) time-periods using the late time-period as
the referent group. Results: Logistic regression analyses assessing timeperiod
and demographic variables reveal trends and odds ratios with 95%
confidence intervals (OR; CI) for chemoRT variables. Our findings showed a
stepwise increase in the odds of PreOP Tx to PostOP Tx across
Early, Middle, to Late time-periods (OREarly/Late�0.11; 0.10, 0.13,
ORMiddle/Late�0.36; 0.32, 0.40). Age �40 and 40-49, independently
predicted higher odds of PreOP Tx than PostOP Tx compared to age 50-74,
while the findings for subjects age 75� were similar to those seen in the
age 50-74 group (OR�40/50-74�1.63; 1.30, 2.05, OR40-49/50-74�1.18; 1.03, 1.36, OR75�/50-74�1.04; 0.90, 1.18). Females showed lower odds
of PreOP Tx to PostOP Tx than males (ORFemale/Male�0.85; 0.77, 0.93).
Odds of PreOP Tx to PostOP Tx were significantly lower among Asian/Other
(A/O) and Hispanic relative to Non-Hispanic White (NHW), while findings
were similar to NHW for Non-Hispanic Black (NHB) (ORA/O/NHW�0.85; 0.74, 0.98, ORHispanic/NHW�0.84; 0.73, 0.96, ORNHB/NHW�0.92; 0.73,
1.15). SES did not predict odds of PreOP Tx versus PostOP Tx. Conclusions:
These findings depict independent increases in PreOP Tx across the three
time-periods among stage II and III rectal cancer patients receiving radical
operations. Further analyses will evaluate survival characteristics predicted
by changes in perioperative therapies for stage II and III rectal cancer
patients.
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