Breast Cancer Survivorship Tool: Facilitating breast cancer survivorship care for family physicians and patients.

OBJECTIVE: To create an evidence-based national Breast Cancer Survivorship (BCS) Tool that facilitates appropriate care of breast cancer patients by primary care providers after patients have completed adjuvant therapy. SOURCES OF INFORMATION: MEDLINE and PubMed were searched from 2002 to 2018 with the key words breast cancer, survivorship, survivorship care plan, guideline, review, meta-analysis, chemotherapy, radiotherapy, treatment complications, adverse effects, late effects, screening, health promotion, and follow up care. National or provincial cancer care organization guidelines were also reviewed. Evidence was graded as level I, II, or III. MAIN MESSAGE: The BCS Tool provides an evidence-based template to ensure seamless transitions of care from cancer centres to primary care. Four steps of survivorship care are outlined in this article: care knowledge and coordination, cancer surveillance, management of long-term side effects of treatment, and health promotion. CONCLUSION: The BCS Tool will support primary care providers in ensuring breast cancer survivors receive high-quality, evidence-based care.

Outil de soutien aux survivantes du cancer du sein: Faciliter les soins de survie au cancer du sein à l'intention des médecins de famille et des patientes.

OBJECTIF: Produire un Outil national de soutien aux survivantes d'un cancer du sein (SSCS) qui facilite des soins appropriés, par les professionnels des soins primaires, aux patientes qui ont eu un cancer du sein après avoir terminé leur thérapie adjuvante. SOURCES DES DONNÉES: Une recension a été effectuée dans MEDLINE et PubMed pour trouver des ouvrages publiés de 2002 à 2018 au moyen des mots clés en anglais breast cancer, survivorship, survivorship care plan, guideline, review, meta-analysis, chemotherapy, radiotherapy, treatment complications, adverse effects, late effects, screening, health promotion et follow up care. Les lignes directrices nationales et provinciales des organisations de cancérologie ont aussi fait l'objet d'une revue. Les données probantes sont classées comme étant de niveau I, II ou III. MESSAGE PRINCIPAL: L'Outil SSCS présente un modèle fondé sur des données probantes pour assurer un transfert ininterrompu des soins des centres de cancérologie vers les soins primaires. Cet article explique les 4 étapes de la survie : la connaissance et la coordination des soins, la surveillance du cancer, la prise en charge des effets à long terme du traitement et la promotion de la santé. CONCLUSION: L'Outil SSCS aidera les professionnels des soins primaires à assurer que les survivantes d'un cancer du sein reçoivent des soins de grande qualité et fondés sur des données probantes.

Combination of cellular population data and CytoDiff analyses for the diagnosis of lymphocytosis.

BACKGROUND: Differentials with moderate lymphocytosis are common in hematology laboratories and it is important in these cases to discriminate monoclonal from reactive lymphocytosis (RL). Blood smear reflex examination is dependent of the expertise of a cytologist, time-consuming and not always informative. Therefore, rapid and easy orientation parameters are clearly needed to discriminate malignant from RL. METHODS: The differential performed by the Beckman-Coulter analyzers is based on the determination of three parameters (volume, conductivity and scatter of the cell subpopulations) called cellular population data (CPD). This study evaluated CPD in 332 patients with a typical B-chronic lymphocytic leukemia (B-CLL), 90 patients with other B-lymphoproliferative diseases (OLPD) and 55 patients with a proven RL, and established a discriminating protocol to identify these pathologies. Secondly, this approach was evaluated in a prospective study including 102 patients with lymphocyte counts above 3.5 × 10(9)/L and in each case the diagnosis suggested by CPD was compared with conventional flow cytometry (FC) analysis and that obtained using CytoDiff reagent, a combination of six antibodies/five colors which performs a rapid WBC differential by FC. RESULTS: Lymphocyte anisocytosis was observed for malignant and RL. A low lymphocyte volume identifies monoclonal B-cell lymphocytosis and classical B-CLL. CytoDiff analysis is helpful when lymphocyte volume is in the normal range. A ratio B-Ly/total Ly count >0.32 is suggestive of a B-malignancy, whereas a non-cytotoxic T-lymphocyte count above 2.43 × 10(9)/L suggests RL. CONCLUSIONS: The analysis of CPD in combination with CytoDiff analysis shows promise for the rapid and accurate identification of lymphocyte pathologies in routine practice.

Multicenter study of ZAP-70 expression in patients with B-cell chronic lymphocytic leukemia using an optimized flow cytometry method.

BACKGROUND: Flow cytometry allows specific assessment of the expression of ZAP-70, a promising new prognostic factor in B-cell chronic lymphocytic leukemia (B-CLL), but suffers from a lack of multicenter standardization. DESIGN AND METHODS: An optimized method for direct detection of ZAP-70 in flow cytometry was tested in a multicenter fashion. Adapted for frozen cells, this method includes a normalization step by addition of B cells from a pool of peripheral blood mononuclear cells collected from normal donors. ZAP-70 expression levels were assessed for 153 patients with typical B-cell chronic lymphocytic leukemia chronic lymphocytic leukemia. Results were expressed as the ratio of ZAP-70 mean fluorescence intensity between B-CLL cells and normal B cells. RESULTS: The statistically optimized cut-off of ZAP-70 positivity was a ratio of 1.4. Concordance between ZAP-70 and CD38 expression was 67%. Concordance between the mutational status of IgVH genes and ZAP-70 or CD38 expression was 87% and 65%, respectively. ZAP-70 was significantly expressed in 28%, 54% and 61% of patients with Binet stages A, B and C B-cell chronic lymphocytic leukemia, respectively (p=0.008). The absence of ZAP-70 expression was associated with isolated del(13q14), a cytogenetic abnormality with a good prognosis, while most patients with the del(17p13) poor prognosis cytogenetic marker expressed ZAP-70 (p<10(-5)). ZAP-70 expression was not related to the other poor prognosis cytogenetic abnormality del(11q22.3) nor to trisomy 12. CONCLUSIONS: This new technique provides highly reliable results well correlated with the mutational status of IgVH genes, CD38 expression, Binet stage and cytogenetic abnormalities. This robust discriminative technique appears of particular interest for routine diagnosis and assessment of ZAP-70 expression in large, prospective, multicenter therapeutic trials.