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Clinical decision making and multidisciplinary team meetings (MDMs) in early breast cancer. Is the agreement between planned and applied therapeutic program?
abstracts
235P
Study on the socioeconomic and clinical factors affecting the proportion of breast conserving surgery in Chinese women breast cancer
J. Zhang Breast Cancer Department, Tianjin Cancer Hospital, Tianjin, China Background: This study intends to investigate the socioeconomic and clinical factors affecting the proportion of breast conserving surgery (BCS) in China. Methods: A total of 51237 breast cancer patients were treated in Tianjin Medical University cancer institute &Hospital from January 2005 to January 2018. In order to improve the success rate of BCS, we choose 5660 patients prepared to be treated by BCS to make analysis of independent factors affecting initial positive margins. Finally, we analyzed the survival trend of breast cancer patients after increasing the proportion of BCS by comparing the locoregional free survival (LRRFS), distant metastasis free survival (DMFS), overall survival (OS) of breast cancer patients. Results: Multivariate analysis showed the distance from nipple (P ¼ 0.030), tumor distribution along the duct (OR¼2.599,P<0.001), pathological subtype (P < 0.001) and lymph node metastasis (OR ¼ 0.299, P < 0.001), no preoperative MRI examination (OR ¼ 1.291,p¼0.001)were independent predictors of positive resection margins. Multivariate analysis revealed that tumor size(OR¼0.706,P<0.001), non-mass enhancement (NME)(OR¼4.443,P¼0.001), malignant enhancement surrounding tumor (OR¼1.647, P<0.001) were independent predictors of positive resection margins. The survival analysis of breast cancer patients after increasing the proportion of BCS revealed that the 5-LRRFS of 2005-2010 and 2011-2013 were 97.2%,98.4%, respectively. The 5-DMFS of 2005-2010 and 2011-2013 were 94.1%, 95.2 %, respectively, without significant difference. The OS of 2005-2010 and 2011-2013 were 96.4%, 97.9% respectively. Conclusions: In China,we should gradually reduce the influence of socioeconomic factors on the proportion of breast conserving surgery in the future. Preoperative MRI should be encouraged in patients preparing for BCS. Clinicopathological characteristics and MRI findings are significantly associated with a positive resection margin in breast cancer patients. Legal entity responsible for the study: The author. Funding: The National Natural Science Foundation of China (81672623). Disclosure: The author has declared no conflicts of interest.
v78 | Breast Cancer, Early Stage
236P
Clinical decision making and multidisciplinary team meetings (MDMs) in early breast cancer. Is the agreement between planned and applied therapeutic program?
M. Giavarra1,2, E. Bertoli1,2, V. Buoro1,2, D. Zara1,2, G. Targato1,2, L. Palmero1,2, M.G. Vitale1,2, G. Pelizzari3,4, D. Basile3,4, L. Gerratana3,4, M. Bonotto5, C. Andreetta5, M. Cinausero5, G. Pascoletti5, E. Poletto5, S. Russo5, F. Puglisi3,4, G. Fasola5, M. Mansutti5, A.M. Minisini5 1 Oncologia Medica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italia, 2 Dipartimento di Medicina (DAME), Universit a degli Studi di Udine, Udine, Italy, 3 Dipartimento di Medicina (DAME), Universit a di Udine, Udine, Italia, 4Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, 5 Italy, Oncologia Medica, Azienda Sanitaria Universitaria Integrata di Udine - Ospedale Santa Maria della Misericordia, Udine, Italy Background: Cancer multidisciplinary team meetings (MDMs) are commonly acknowledged as a good clinical practice. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early breast cancer (EBC). In this setting, the purpose of the study was to define whether there was agreement between the planned program (i.e. MDMs-based decision) and that actually applied (i.e. actual therapeutic choice, ATC). In addition, the study explored factors associated with discordance. Methods: We conducted a monocentric retrospective study of a consecutive series of 291 pts with new diagnosis of EBC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. Results: Median age was 62 years (range 27-88 years). Among invasive EBC patients, the most frequent phenotype was luminal-A (38%), followed by luminal-B (33%), HER2positive (12%) and triple negative (5%). Thirty-four pts (12%) had diagnosis of in situ carcinoma (DCIS). Median time from MDMs discussion to first oncological examination was two weeks. Rate of discordance between MDMs-based decision and final choice, during face to face consultation with the oncologist, was 15.8% (46/291). Among cases with discordance, 19 pts (41.3%) had age > 70 years; 8 pts (17%) had a diagnosis of DCIS, 13 pts (28%) luminal-B carcinoma, 12 pts (26%) luminal-A, 9 pts (20%) HER2-positive and 4 pts (9%) triple negative EBC. The most frequent reason for changing the MDMs-based program was clinical decision by the oncologist at the first evaluation (87%). Follow-up was preferred to the chemotherapy proposed within the MDMs by 15% of pts, and to the endocrine therapy in 39% cases (among these, 44.5% had diagnosis of DCIS). In our study 16/46 pts (35%) had a therapeutic change from chemotherapy to endocrine therapy: among these pts, 7/16 had a luminal-B and 6/16 had a HER2-positive disease. Further analysis aiming at evaluating variables which could predict discordance between MDMs proposal and face to face oncological consultation are ongoing. Conclusions: The results of our study could be useful for enhance the role of MTD and identify unmet needs in decision making process in EBC. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
237P
The value of genetic counselling in breast cancer genetic testing and clinical management
V. Kiesel1, G. Wishart2 1 Genetics, Genehealth UK, Cambridge, UK, 2Surgery, Check4Cancer, Cambridge, UK Background: Multiple national1 and international2 guidelines recommend that genetic testing is provided by genetic experts in the context of genetic counselling. However, there has been little research performed assessing the utility of genetic counselling. This study was performed to determine the value of genetic counselling for individuals undergoing breast cancer genetic testing. Methods: GeneHealth UK clinical records for patients seen between the 1st January 2018 and 30th June 2018 for breast cancer were reviewed to determine what was discussed during the consultations. Data was collated in four categories: a) appropriateness of genetic testing, b) psychological support, c) implications for relatives d) management guidance. Results: Of a total of 130 patients, 74% (96) had breast cancer, and 26% (34) had a family history. 10% of tested patients had a pathogenic genetic variant. 98% of patients had at least one discussion in the assessed areas; 16% had two, 21% had three and 52% had four or more. Genetic counselling helped 15% of patients decide not to proceed with genetic testing: either because a relative would be more appropriate to test (5%), the patient had a low risk of a BRCA mutation (3%) or for psychological reasons (7%). Psychological support was provided to 15% of patients including the provision of support resources in 12% and referral for counselling in 2% of cases. Genetic counsellors assess the whole family and were therefore able to provide screening recommendations for relatives in 62% of cases and assess risk of other familial conditions in 2% of families. Of importance external referrals were made in 6% of patients. Conclusions: Genetic counselling provides significant psychosocial and practical benefits in the provision of breast cancer genetics: including advice for the whole family, ensuring genetic testing is appropriate and referral to appropriate external healthcare agencies. 1 NICE Guidance 2 NCCN Guidelines. Legal entity responsible for the study: The authors. Funding: Has not received any funding.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.060/5576209 by guest on 24 October 2019
Methods: Twenty breast cancer female survivors were recruited to a single-arm clinical trial consisting of sequential 16 weeks (wk) of control phase (CP) and 16 wk intervention phase (IP). Four evaluations were carried out: M1 (8 wk on CP), M2 (immediately previous IP), M3 (8 wk CP) and M4 (16 wk IP). The IP consisted of 3 sessions per week of combined aerobic and strength exercise (60min) at moderate to vigorous exercise (65-85% of maximum heart rate or 6-8 points on OMNI scale). The primary endpoint was QoL, which was evaluated by EORTC QLQ-C30 questionnaire. Secondary endpoints included handgrip strength and sit-to-stand (STS) test. Results: Of the 20 recruited women, 19 initiated and 15 concluded the program, with a mean compliance to the exercise intervention of 63.6%. The median age was 59 years old (39-72). All but 3 were diagnosed with invasive carcinoma. After surgery, 13 (62%) underwent radiotherapy, 15 (71%) chemotherapy and 18 (86%) were under hormonotherapy. During the control phase, no significant differences were observed in the efficacy variables. There was no changes over time for any domain of QoL, except for physical functioning scale (p ¼ 0.038), where it was observed a trend to increase between M2 and M3 (77.3614.0 to 85.3610.1, p ¼ 0.051). A significant increase in handgrip strength of non-operated (22.263.9 to 25.665.3 kg.f, p ¼ 0.004) and operated limb (22.664.7 to 26.966.6 kg.f, p ¼ 0.001) was shown after exercise training. Similar results were also observed for STS test [12 (11-13.5) to 17 (13-21) repetitions, p ¼ 0.002]. Conclusions: An exercise program appears to be beneficial for QoL, particularly in the physical functioning of breast cancer survivors. Moreover, it seems to have an important role on strength levels. Legal entity responsible for the study: Associac¸~ao de Investigac¸~ao e Cuidados de Suporte em Oncologia. Funding: Liga Portuguesa Contra o Cancro. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
235P
Study on the socioeconomic and clinical factors affecting the proportion of breast conserving surgery in Chinese women breast cancer
J. Zhang Breast Cancer Department, Tianjin Cancer Hospital, Tianjin, China Background: This study intends to investigate the socioeconomic and clinical factors affecting the proportion of breast conserving surgery (BCS) in China. Methods: A total of 51237 breast cancer patients were treated in Tianjin Medical University cancer institute &Hospital from January 2005 to January 2018. In order to improve the success rate of BCS, we choose 5660 patients prepared to be treated by BCS to make analysis of independent factors affecting initial positive margins. Finally, we analyzed the survival trend of breast cancer patients after increasing the proportion of BCS by comparing the locoregional free survival (LRRFS), distant metastasis free survival (DMFS), overall survival (OS) of breast cancer patients. Results: Multivariate analysis showed the distance from nipple (P ¼ 0.030), tumor distribution along the duct (OR¼2.599,P<0.001), pathological subtype (P < 0.001) and lymph node metastasis (OR ¼ 0.299, P < 0.001), no preoperative MRI examination (OR ¼ 1.291,p¼0.001)were independent predictors of positive resection margins. Multivariate analysis revealed that tumor size(OR¼0.706,P<0.001), non-mass enhancement (NME)(OR¼4.443,P¼0.001), malignant enhancement surrounding tumor (OR¼1.647, P<0.001) were independent predictors of positive resection margins. The survival analysis of breast cancer patients after increasing the proportion of BCS revealed that the 5-LRRFS of 2005-2010 and 2011-2013 were 97.2%,98.4%, respectively. The 5-DMFS of 2005-2010 and 2011-2013 were 94.1%, 95.2 %, respectively, without significant difference. The OS of 2005-2010 and 2011-2013 were 96.4%, 97.9% respectively. Conclusions: In China,we should gradually reduce the influence of socioeconomic factors on the proportion of breast conserving surgery in the future. Preoperative MRI should be encouraged in patients preparing for BCS. Clinicopathological characteristics and MRI findings are significantly associated with a positive resection margin in breast cancer patients. Legal entity responsible for the study: The author. Funding: The National Natural Science Foundation of China (81672623). Disclosure: The author has declared no conflicts of interest.
v78 | Breast Cancer, Early Stage
236P
Clinical decision making and multidisciplinary team meetings (MDMs) in early breast cancer. Is the agreement between planned and applied therapeutic program?
M. Giavarra1,2, E. Bertoli1,2, V. Buoro1,2, D. Zara1,2, G. Targato1,2, L. Palmero1,2, M.G. Vitale1,2, G. Pelizzari3,4, D. Basile3,4, L. Gerratana3,4, M. Bonotto5, C. Andreetta5, M. Cinausero5, G. Pascoletti5, E. Poletto5, S. Russo5, F. Puglisi3,4, G. Fasola5, M. Mansutti5, A.M. Minisini5 1 Oncologia Medica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italia, 2 Dipartimento di Medicina (DAME), Universit a degli Studi di Udine, Udine, Italy, 3 Dipartimento di Medicina (DAME), Universit a di Udine, Udine, Italia, 4Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, 5 Italy, Oncologia Medica, Azienda Sanitaria Universitaria Integrata di Udine - Ospedale Santa Maria della Misericordia, Udine, Italy Background: Cancer multidisciplinary team meetings (MDMs) are commonly acknowledged as a good clinical practice. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early breast cancer (EBC). In this setting, the purpose of the study was to define whether there was agreement between the planned program (i.e. MDMs-based decision) and that actually applied (i.e. actual therapeutic choice, ATC). In addition, the study explored factors associated with discordance. Methods: We conducted a monocentric retrospective study of a consecutive series of 291 pts with new diagnosis of EBC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. Results: Median age was 62 years (range 27-88 years). Among invasive EBC patients, the most frequent phenotype was luminal-A (38%), followed by luminal-B (33%), HER2positive (12%) and triple negative (5%). Thirty-four pts (12%) had diagnosis of in situ carcinoma (DCIS). Median time from MDMs discussion to first oncological examination was two weeks. Rate of discordance between MDMs-based decision and final choice, during face to face consultation with the oncologist, was 15.8% (46/291). Among cases with discordance, 19 pts (41.3%) had age > 70 years; 8 pts (17%) had a diagnosis of DCIS, 13 pts (28%) luminal-B carcinoma, 12 pts (26%) luminal-A, 9 pts (20%) HER2-positive and 4 pts (9%) triple negative EBC. The most frequent reason for changing the MDMs-based program was clinical decision by the oncologist at the first evaluation (87%). Follow-up was preferred to the chemotherapy proposed within the MDMs by 15% of pts, and to the endocrine therapy in 39% cases (among these, 44.5% had diagnosis of DCIS). In our study 16/46 pts (35%) had a therapeutic change from chemotherapy to endocrine therapy: among these pts, 7/16 had a luminal-B and 6/16 had a HER2-positive disease. Further analysis aiming at evaluating variables which could predict discordance between MDMs proposal and face to face oncological consultation are ongoing. Conclusions: The results of our study could be useful for enhance the role of MTD and identify unmet needs in decision making process in EBC. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
237P
The value of genetic counselling in breast cancer genetic testing and clinical management
V. Kiesel1, G. Wishart2 1 Genetics, Genehealth UK, Cambridge, UK, 2Surgery, Check4Cancer, Cambridge, UK Background: Multiple national1 and international2 guidelines recommend that genetic testing is provided by genetic experts in the context of genetic counselling. However, there has been little research performed assessing the utility of genetic counselling. This study was performed to determine the value of genetic counselling for individuals undergoing breast cancer genetic testing. Methods: GeneHealth UK clinical records for patients seen between the 1st January 2018 and 30th June 2018 for breast cancer were reviewed to determine what was discussed during the consultations. Data was collated in four categories: a) appropriateness of genetic testing, b) psychological support, c) implications for relatives d) management guidance. Results: Of a total of 130 patients, 74% (96) had breast cancer, and 26% (34) had a family history. 10% of tested patients had a pathogenic genetic variant. 98% of patients had at least one discussion in the assessed areas; 16% had two, 21% had three and 52% had four or more. Genetic counselling helped 15% of patients decide not to proceed with genetic testing: either because a relative would be more appropriate to test (5%), the patient had a low risk of a BRCA mutation (3%) or for psychological reasons (7%). Psychological support was provided to 15% of patients including the provision of support resources in 12% and referral for counselling in 2% of cases. Genetic counsellors assess the whole family and were therefore able to provide screening recommendations for relatives in 62% of cases and assess risk of other familial conditions in 2% of families. Of importance external referrals were made in 6% of patients. Conclusions: Genetic counselling provides significant psychosocial and practical benefits in the provision of breast cancer genetics: including advice for the whole family, ensuring genetic testing is appropriate and referral to appropriate external healthcare agencies. 1 NICE Guidance 2 NCCN Guidelines. Legal entity responsible for the study: The authors. Funding: Has not received any funding.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz240.060/5576209 by guest on 24 October 2019
Methods: Twenty breast cancer female survivors were recruited to a single-arm clinical trial consisting of sequential 16 weeks (wk) of control phase (CP) and 16 wk intervention phase (IP). Four evaluations were carried out: M1 (8 wk on CP), M2 (immediately previous IP), M3 (8 wk CP) and M4 (16 wk IP). The IP consisted of 3 sessions per week of combined aerobic and strength exercise (60min) at moderate to vigorous exercise (65-85% of maximum heart rate or 6-8 points on OMNI scale). The primary endpoint was QoL, which was evaluated by EORTC QLQ-C30 questionnaire. Secondary endpoints included handgrip strength and sit-to-stand (STS) test. Results: Of the 20 recruited women, 19 initiated and 15 concluded the program, with a mean compliance to the exercise intervention of 63.6%. The median age was 59 years old (39-72). All but 3 were diagnosed with invasive carcinoma. After surgery, 13 (62%) underwent radiotherapy, 15 (71%) chemotherapy and 18 (86%) were under hormonotherapy. During the control phase, no significant differences were observed in the efficacy variables. There was no changes over time for any domain of QoL, except for physical functioning scale (p ¼ 0.038), where it was observed a trend to increase between M2 and M3 (77.3614.0 to 85.3610.1, p ¼ 0.051). A significant increase in handgrip strength of non-operated (22.263.9 to 25.665.3 kg.f, p ¼ 0.004) and operated limb (22.664.7 to 26.966.6 kg.f, p ¼ 0.001) was shown after exercise training. Similar results were also observed for STS test [12 (11-13.5) to 17 (13-21) repetitions, p ¼ 0.002]. Conclusions: An exercise program appears to be beneficial for QoL, particularly in the physical functioning of breast cancer survivors. Moreover, it seems to have an important role on strength levels. Legal entity responsible for the study: Associac¸~ao de Investigac¸~ao e Cuidados de Suporte em Oncologia. Funding: Liga Portuguesa Contra o Cancro. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology