- Email: [email protected]
P097 Does the mode of presentation impact on distress levels in early stage breast cancer?
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Poster Abstracts I / The Breast 24S1 (2015) S26–S86
patients. However, does this newly developed attitude eclipse the fact that pregnancy must be effectively prevented after diagnosis and during adjuvant therapy? In a self-report questionnaire, we surveyed oncologists in Switzerland, Austria and Germany with the aim of evaluating attitudes towards the issue “contraception in young breast cancer patients” and how patients are being counseled in the practical clinical setting. Methods: We conducted a cross-sectional survey. The survey instrument (poster Table 1), specifically created for this study, included four multiple-choice questions on the oncologists’ attitude regarding contraception in young BC patients and how they addressed this issue in daily practice. A total of 120 colleagues were invited to participate in the survey. 101 colleagues (84.2%) agreed to participate and completed the questionnaire. Results: Almost all respondents (99%) stated that the issue of contraception is an important aspect in the surveillance of young BC patients (Table 1, Question 1). For the vast majority of the respondents (90%), this item was not only theoretically considered important but was part of the standard discussion with young BC patients before starting adjuvant therapy (Question 2). Once the therapy had started, only 30% of the respondents reported that they actively ask whether the patients actually use contraceptive measures (Question 3). The majority of the respondents admitted that they do not regularly address the question of contraceptive use during ongoing adjuvant therapy (“rarely”: 45%; “never”: 10%). Only 20% of the respondents reported that they (a) inform the patients that reliable contraception is necessary before starting adjuvant therapy, (b) ask whether contraceptive methods are used during ongoing therapy, and (c) regularly refer their patients to specialist counseling by a gynecologist (Question 4). Conclusion: Oncologists should be aware that the use of reliable contraceptive methods should not only be discussed before starting adjuvant therapy, but also during ongoing therapy. Oncologists should consider actively referring young BC patients to gynecologists to ensure proper contraceptive counseling. Disclosure of Interest: No significant relationships. P096 Comparison of adjuvant TAC vs. FEC-D in women <50 with node positive, HER2 negative breast cancer R.E. Lester1 *, D. Tilley2 , X. Kostaras2 , J.W. Henning1 , A. Joy3 , S. Lupichuk1 . 1 Medical Oncology, Tom Baker Cancer Centre, Calgary, Canada, 2 Guideline Utilization Resource Unit, Calgary, Canada, 3 Cross Cancer Institute, Edmonton, Canada Goals: A retrospective cohort study to compare TAC (taxotere, adriamycin and cyclophosphamide) and FEC-D (5-fluorouracil, epirubicin and cyclophosphamide followed by docetaxel) in terms of disease free survival (DFS), overall survival (OS), Granulocyte-colony stimulating factor (G-CSF) use, and adverse events. Methods: Women under the age of 50 with node positive, HER2 negative breast cancer (BC) diagnosed from 2008 through 2012 were identified from the Alberta Cancer Registry (ACR). Chart review was undertaken to confirm chemotherapy (CT) regimen. Patients who did not receive CT, had neoadjuvant CT, or had a regimen other than TAC or FEC-D, were excluded. Patient and tumour characteristics, type of surgery, radiation, G-CSF use, adverse events, recurrence, and death were also recorded. Statistical analysis included: t-tests and chisquare tests where appropriate to compare baseline characteristics between cohorts; G-CSF use and adverse events; Kaplan–Meier technique for plotting DFS and OS; and, log-rank tests for comparing DFS and OS. Results: From 2008 through 2012, there were 780 women under the age of 50 diagnosed with node positive, HER2 negative BC, and of these, 496 received either TAC (198) or FEC-D (274). Demographic variables, tumour characteristics, and other treatments were similar
for the TAC and FEC-D cohorts. With median follow up of 49.6 months, DFS was 91.4% for TAC and 92% for FEC-D, HR 1.105 (p = 0.76; 95% CI 0.590–2.071). OS was 96% for TAC and 95.3% for FEC-D, HR 0.923 (p = 0.86; 95% CI 0.382–2.231). There were no differences in terms of incidence of dose reduction and grade 3–4 toxicities. Of patients receiving TAC 96.4% had G-CSF support compared to 71.5% receiving FEC-D (p < 0.001). Overall, the incidence of febrile neutropenia (FN) was 12.0% for TAC and 16.0% for FEC-D (p = 0.29). G-CSF-supported vs. G-CSF-unsupported FN occurred in 11.1% vs. 33.3% of patients receiving TAC, 2.9% vs. 8.1% of patients receiving the FEC portion of FEC-D and 4.1% vs. 17.6% of patients receiving the D portion of FEC-D. There was one treatment-related death in each cohort. During the follow-up period, there was one case of acute leukemia in the FEC-D cohort and no documented cardiac events. Conclusion: We could not detect any differences between the TAC and FEC-D cohorts in terms of DFS, OS, or adverse events. This study supports the use of prophylactic G-CSF for the prevention of FN in patients receiving TAC chemotherapy. With respect to FEC-D chemotherapy, primary G-CSF support could be limited to the docetaxel portion of chemotherapy, leading to potential cost savings. Disclosure of Interest: No significant relationships. P097 Does the mode of presentation impact on distress levels in early stage breast cancer? L.J. McSweeney1 , J. Battley1 , L. Sheehan1 , E. Lee2 , D. O’Mahony1 , S. O’Reilly3 *. 1 cork University Hospital, Cork, Ireland, 2 South Infirmary Victoria Hospital, Cork, Ireland, 3 Department of Medical Oncology, Cork University Hospital, Cork, Ireland Goals: To investigate whether or not a statistically significant difference exists between levels of psychological distress in women diagnosed with breast cancer through routine screening in a national screening program (Breastcheck) versus those with a symptomatic presentation. The goals of the study included 1. To examine the impact of mode of presentation on distress levels 2. To determine whether levels of distress in the study subjects were in line with with internationally reported statistics 3. To facilitate discussion of the need for routine distress screening in this population. Methods: We assessed levels of distress in 93 female patients with either screen detected or symptomatic breast cancer being treated with curative intent. The Hospital Anxiety and Distress Scale (HADS) scores were used as a marker of distress. HADS-A and HADS-D measure anxiety and depression respectively. Demographic and clinical data were compiled from patient files and an additional 12 item questionaire. Data were analysed using SPSS software. Ethical approval was received from the regional ethics committee. Results: After adjusting for confounding factors no statistically significant difference was observed between HADS score between the 2 cohorts. 47% of screen detected patients were HADS-A positive compared with 43% of the symptomatic cohort. HADS-D positive scores were observed in 19% of screened and 15% of symptomatic patients. 50.5% of patients scored above the threshold for HADS-A, HADS-D or both. Age over 60 years was associated with concomittant positive HADS-A and HADS-D screening results. Financial stress was associated with positive HADS-D scores. Conclusion: The majority of patients in the study experienced distress. Mode of presentation did not impact on this incidence. Consideration should be made for routine screening in newly diagnosed patients with early stage breast cancer particularly those over 60 years or who are in financial distress. Disclosure of Interest: No significant relationships.
Poster Abstracts I / The Breast 24S1 (2015) S26–S86
patients. However, does this newly developed attitude eclipse the fact that pregnancy must be effectively prevented after diagnosis and during adjuvant therapy? In a self-report questionnaire, we surveyed oncologists in Switzerland, Austria and Germany with the aim of evaluating attitudes towards the issue “contraception in young breast cancer patients” and how patients are being counseled in the practical clinical setting. Methods: We conducted a cross-sectional survey. The survey instrument (poster Table 1), specifically created for this study, included four multiple-choice questions on the oncologists’ attitude regarding contraception in young BC patients and how they addressed this issue in daily practice. A total of 120 colleagues were invited to participate in the survey. 101 colleagues (84.2%) agreed to participate and completed the questionnaire. Results: Almost all respondents (99%) stated that the issue of contraception is an important aspect in the surveillance of young BC patients (Table 1, Question 1). For the vast majority of the respondents (90%), this item was not only theoretically considered important but was part of the standard discussion with young BC patients before starting adjuvant therapy (Question 2). Once the therapy had started, only 30% of the respondents reported that they actively ask whether the patients actually use contraceptive measures (Question 3). The majority of the respondents admitted that they do not regularly address the question of contraceptive use during ongoing adjuvant therapy (“rarely”: 45%; “never”: 10%). Only 20% of the respondents reported that they (a) inform the patients that reliable contraception is necessary before starting adjuvant therapy, (b) ask whether contraceptive methods are used during ongoing therapy, and (c) regularly refer their patients to specialist counseling by a gynecologist (Question 4). Conclusion: Oncologists should be aware that the use of reliable contraceptive methods should not only be discussed before starting adjuvant therapy, but also during ongoing therapy. Oncologists should consider actively referring young BC patients to gynecologists to ensure proper contraceptive counseling. Disclosure of Interest: No significant relationships. P096 Comparison of adjuvant TAC vs. FEC-D in women <50 with node positive, HER2 negative breast cancer R.E. Lester1 *, D. Tilley2 , X. Kostaras2 , J.W. Henning1 , A. Joy3 , S. Lupichuk1 . 1 Medical Oncology, Tom Baker Cancer Centre, Calgary, Canada, 2 Guideline Utilization Resource Unit, Calgary, Canada, 3 Cross Cancer Institute, Edmonton, Canada Goals: A retrospective cohort study to compare TAC (taxotere, adriamycin and cyclophosphamide) and FEC-D (5-fluorouracil, epirubicin and cyclophosphamide followed by docetaxel) in terms of disease free survival (DFS), overall survival (OS), Granulocyte-colony stimulating factor (G-CSF) use, and adverse events. Methods: Women under the age of 50 with node positive, HER2 negative breast cancer (BC) diagnosed from 2008 through 2012 were identified from the Alberta Cancer Registry (ACR). Chart review was undertaken to confirm chemotherapy (CT) regimen. Patients who did not receive CT, had neoadjuvant CT, or had a regimen other than TAC or FEC-D, were excluded. Patient and tumour characteristics, type of surgery, radiation, G-CSF use, adverse events, recurrence, and death were also recorded. Statistical analysis included: t-tests and chisquare tests where appropriate to compare baseline characteristics between cohorts; G-CSF use and adverse events; Kaplan–Meier technique for plotting DFS and OS; and, log-rank tests for comparing DFS and OS. Results: From 2008 through 2012, there were 780 women under the age of 50 diagnosed with node positive, HER2 negative BC, and of these, 496 received either TAC (198) or FEC-D (274). Demographic variables, tumour characteristics, and other treatments were similar
for the TAC and FEC-D cohorts. With median follow up of 49.6 months, DFS was 91.4% for TAC and 92% for FEC-D, HR 1.105 (p = 0.76; 95% CI 0.590–2.071). OS was 96% for TAC and 95.3% for FEC-D, HR 0.923 (p = 0.86; 95% CI 0.382–2.231). There were no differences in terms of incidence of dose reduction and grade 3–4 toxicities. Of patients receiving TAC 96.4% had G-CSF support compared to 71.5% receiving FEC-D (p < 0.001). Overall, the incidence of febrile neutropenia (FN) was 12.0% for TAC and 16.0% for FEC-D (p = 0.29). G-CSF-supported vs. G-CSF-unsupported FN occurred in 11.1% vs. 33.3% of patients receiving TAC, 2.9% vs. 8.1% of patients receiving the FEC portion of FEC-D and 4.1% vs. 17.6% of patients receiving the D portion of FEC-D. There was one treatment-related death in each cohort. During the follow-up period, there was one case of acute leukemia in the FEC-D cohort and no documented cardiac events. Conclusion: We could not detect any differences between the TAC and FEC-D cohorts in terms of DFS, OS, or adverse events. This study supports the use of prophylactic G-CSF for the prevention of FN in patients receiving TAC chemotherapy. With respect to FEC-D chemotherapy, primary G-CSF support could be limited to the docetaxel portion of chemotherapy, leading to potential cost savings. Disclosure of Interest: No significant relationships. P097 Does the mode of presentation impact on distress levels in early stage breast cancer? L.J. McSweeney1 , J. Battley1 , L. Sheehan1 , E. Lee2 , D. O’Mahony1 , S. O’Reilly3 *. 1 cork University Hospital, Cork, Ireland, 2 South Infirmary Victoria Hospital, Cork, Ireland, 3 Department of Medical Oncology, Cork University Hospital, Cork, Ireland Goals: To investigate whether or not a statistically significant difference exists between levels of psychological distress in women diagnosed with breast cancer through routine screening in a national screening program (Breastcheck) versus those with a symptomatic presentation. The goals of the study included 1. To examine the impact of mode of presentation on distress levels 2. To determine whether levels of distress in the study subjects were in line with with internationally reported statistics 3. To facilitate discussion of the need for routine distress screening in this population. Methods: We assessed levels of distress in 93 female patients with either screen detected or symptomatic breast cancer being treated with curative intent. The Hospital Anxiety and Distress Scale (HADS) scores were used as a marker of distress. HADS-A and HADS-D measure anxiety and depression respectively. Demographic and clinical data were compiled from patient files and an additional 12 item questionaire. Data were analysed using SPSS software. Ethical approval was received from the regional ethics committee. Results: After adjusting for confounding factors no statistically significant difference was observed between HADS score between the 2 cohorts. 47% of screen detected patients were HADS-A positive compared with 43% of the symptomatic cohort. HADS-D positive scores were observed in 19% of screened and 15% of symptomatic patients. 50.5% of patients scored above the threshold for HADS-A, HADS-D or both. Age over 60 years was associated with concomittant positive HADS-A and HADS-D screening results. Financial stress was associated with positive HADS-D scores. Conclusion: The majority of patients in the study experienced distress. Mode of presentation did not impact on this incidence. Consideration should be made for routine screening in newly diagnosed patients with early stage breast cancer particularly those over 60 years or who are in financial distress. Disclosure of Interest: No significant relationships.