Retrospective evaluation of Penguin Cold Caps for chemotherapy-induced alopecia.

BACKGROUND: Scalp cooling is an increasingly recognized non-pharmacologic approach to minimize chemotherapy-induced alopecia (CIA). Several commercially available machine-based and manual scalp cooling systems are available; however, literature reports of effectiveness are highly variable. The purpose of this study was to determine real-world tolerability and subjective effectiveness of a manual cold capping system in minimizing CIA across a variety of patient race and hair types. This study was a single-institution review of outcomes from manual cold capping. METHODS: We identified retrospective cohort of adult patients who presented to discuss cold capping between January 14, 2019, and March 31, 2022. Data collected from medical records included demographics, decision to pursue/continue cold capping, diagnoses, chemotherapy regimens, hair characteristics (length, thickness, coarseness, type), and subjective perception of percentage of hair retained. Those with successful vs. unsuccessful cold capping (≥ 50% vs. < 50% of hair retained) were compared based on the patient-level factors of interest. FINDINGS: A total of 100 patients initiated cold capping during the study period, and 95% of them completed cold capping. The majority of patients who started cold capping completed it. The median-reported percentage of hair maintained was 75%, and 82/89 (92.1% of patients) had favorable results, defined as ≥ 50% of hair retained. The only patient-level factor associated with favorable response was chemotherapy regimen, with fewer patients receiving doxorubicin-containing regimens having successful hair retention compared to other chemotherapy types (71.4% successful results vs. 95.7% for those receiving paclitaxel-containing regimens and 96.6% for those receiving docetaxel-containing regimens (p = 0.018). There was no difference in success based on patient race/ethnicity or hair characteristics. INTERPRETATION: The overall effectiveness (92.1%) in this study is consistent to higher than many literature reports. One possible reason for the high success in our cohort is compliance with cold capping protocols, meaning applying the cap in the appropriate manner and wearing the cap for the prescribed durations, which may impact effectiveness.

Barriers to genetic testing in newly diagnosed breast cancer patients: Do surgeons limit testing?

BACKGROUND: Genetic testing results influence treatment recommendations in newly diagnosed breast cancer patients. However, at-risk patients do not uniformly undergo genetic testing. The goal of this study was to identify barriers to genetic testing in newly diagnosed breast cancer patients. METHODS: A prospective database of newly diagnosed breast cancer patients meeting specific criteria over an 18-month period was created and retrospectively reviewed. RESULTS: A total of 532 patients were identified at risk for genetic mutation. Of these 313 (59%) patients completed a genetic counseling appointment and 292 (55%) underwent genetic testing. One hundred seven (24%) were never referred to genetic counselors and 89 (17%) were referred but did not complete an appointment. Patients referred to genetics were younger than the nonreferred patients (50.9 vs 60.6 years, P < .001). The 89 women referred to genetics who did not complete an appointment were surveyed and had varied reasons for not completing an appointment. CONCLUSIONS: The largest barrier to genetic testing was lack of physician referral; therefore, provider education must be improved. Appointments should be convenient and providers should proactively discuss the significant implications of testing results.

A Case of a Bilateral Inflammatory Breast Cancer: A Case Report.

Cases of bilateral inflammatory breast cancer (IBC) are extremely rare. Our search criteria only found one other record of metachronous bilateral IBC (1). We present the case of a patient who was treated for IBC with neoadjuvant chemotherapy, modified radical mastectomy (MRM), and whole breast radiation. Less than 1 year later, the patient had a recurrence of IBC on the left chest wall with in the radiated field, as well as a new IBC on the contralateral side. Bilateral IBC is extremely rare. This entity can present challenges for the standard treatment of IBC with neoadjuvant chemotherapy, MRM, and whole breast radiation (2). Our case study shows the importance of scheduled routine imaging, screening with physical examination after IBC management, and good patient compliance in this aggressive disease (3).

The likelihood of additional nodal disease following a positive sentinel lymph node biopsy in breast cancer patients: validation of a nomogram.

BACKGROUND: Sentinel lymph node (SLN) biopsy examination is the current modality for evaluating the axilla in breast cancer patients. A nomogram has been developed to predict the likelihood of non-SLN metastases after a positive SLN biopsy examination. The purpose of this study was to validate the nomogram in a community breast center. METHODS: A prospective database was used to identify breast cancer patients with a positive SLN biopsy examination who underwent a completion axillary lymph node dissection. The nomogram was used to calculate the probability of having non-SLN involvement, and was compared with the observed numbers. RESULTS: The observed incidence of non-SLN involvement showed excellent correlation with the nomogram predicted probability (chi-square test statistic = 5.87; P = .83). CONCLUSIONS: Predicting the risk of additional nodal metastases allows the surgeon and patient to make an individualized decision regarding the need for completion axillary lymph node dissection.