Bridging the Age Gap: a prognostic model that predicts survival and aids in primary treatment decisions for older women with oestrogen receptor-positive early breast cancer.

BACKGROUND: A prognostic model was developed and validated using cancer registry data. This underpins an online decision support tool, informing primary treatment choice for women aged 70 years or older with hormone receptor-positive early breast cancer. METHODS: Data from women diagnosed between 2002 and 2010 in the English Northern and Yorkshire and West Midlands regions were used to develop the model. Primary treatment options of surgery with adjuvant endocrine therapy or primary endocrine therapy were compared. Models predicting the hazard of breast cancer-specific mortality and hazard of other-cause mortality were combined to derive survival probabilities. The model was validated externally using data from the Eastern Cancer Registration and Information Centre. RESULTS: The model was developed using data from 23 842 women, and validated externally on a data set from 14 526 patients. The overall model calibration was good. At 2 and 5 years, predicted mortality from breast cancer and other causes differed from the observed rate by less than 1 per cent. At 5 years, there were slight overpredictions in breast cancer mortality (2629 predicted versus 2556 observed deaths; P = 0·142) and mortality from all causes (6399 versus 6320 respectively; P = 0·583). The discrepancy varied between subgroups. Model discrimination was 0·75 or above for all mortality measures. CONCLUSION: A prognostic model for older women with oestrogen receptor-positive early breast cancer was developed and validated in the present study. This forms a basis for an online decision support tool (https://agegap.shef.ac.uk/).

ANTECEDENTES: Se ha desarrollado y validado un modelo pronóstico utilizando datos del registro de cáncer. Ello ha permitido ofrecer una herramienta online para facilitar la toma de decisiones respecto a la elección del tratamiento inicial en mujeres mayores de 70 años con cáncer de mama precoz y receptores de hormonas positivos. MÉTODOS: Se incluyeron un total de 23.842 mujeres, diagnosticadas entre 2002 y 2010 en las regiones del Norte, Yorkshire y West Midlands inglesas que cumplieron con los criterios de inclusión. Se compararon dos opciones de tratamiento: cirugía primaria asociada a tratamiento endocrino adyuvante o tratamiento primario endocrino. Para estimar la probabilidad de supervivencia se combinaron modelos predictivos para el riesgo de mortalidad específica por cáncer de mama y para el riesgo de mortalidad por otras causas. Se realizó una validación externa con datos del Eastern Cancer Registration and Information Center (n = 14.526). RESULTADOS: La calibración global del modelo fue buena. A los 2 y 5 años, la mortalidad anticipada por cáncer de mama y por otras causas difería de la observada en menos del 1%. A los 5 años, hubo una ligera sobrevaloración de la predicción de mortalidad por cáncer de mama (prevista versus real: 2.629 versus 2.556, P = 0,78) y de la mortalidad por todas las causas (6.399 versus 6.320, P = 0,14). Esta discrepancia varió entre subgrupos. La capacidad discriminativa del modelo fue del 0,75 o superior para todas las medidas de mortalidad. CONCLUSIÓN: En este estudio, se desarrolló y validó un modelo pronóstico para mujeres mayores con cáncer de mama precoz positivo para receptores de estrógenos. Esta herramienta que facilita la toma de decisiones está disponible online (https://agegap.shef.ac.uk/).

Adjuvant Chemotherapy for Breast Cancer in Older Women: An Analysis of Retrospective English Cancer Registration Data.

AIMS: Adjuvant chemotherapy is recommended as a treatment for women with high recurrence risk early breast cancer. Older women are less likely to receive chemotherapy than younger women. This study investigated the impact of chemotherapy on breast cancer-specific survival in women aged 70 + years using English registry data. MATERIALS AND METHODS: Cancer registration data were obtained from two English regions from 2002 to 2012 (n = 29 728). The impact of patient-level characteristics on the probability of receiving adjuvant chemotherapy was explored using logistic regression. Survival modelling was undertaken to show the effect of chemotherapy and age/health status on breast cancer-specific survival. Missing data were handled using multiple imputation. RESULTS: In total, 11 735 surgically treated early breast cancer patients were identified. Use of adjuvant chemotherapy has increased over time. Younger age at diagnosis, increased nodal involvement, tumour size and grade, oestrogen receptor-negative or human epidermal growth factor receptor 2-positive disease were all associated with increased probability of receiving chemotherapy. Chemotherapy was associated with a significant reduction in the hazard of breast cancer-specific mortality in women with high risk cancer, after adjusting for patient-level characteristics (hazard ratio 0.74, 95% confidence interval 0.67-0.81). DISCUSSION: Chemotherapy is associated with an improved breast cancer-specific survival in older women with early breast cancer at high risk of recurrence . Lower rates of chemotherapy use in older women may, therefore, contribute to inferior cancer outcomes. Decisions on potential benefits for individual patients should be made on the basis of life expectancy, treatment tolerance and patient preference.

Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival.

BACKGROUND: Primary endocrine therapy is used as an alternative to surgery in up to 40 per cent of women with early breast cancer aged over 70 years in the UK. This study investigated the impact of surgery versus primary endocrine therapy on breast cancer-specific survival (BCSS) in older women. METHODS: Cancer registration data for 2002-2010 were obtained from two English regions. A retrospective analysis was performed for women with oestrogen receptor (ER)-positive disease, using statistical modelling to show the effect of treatment (surgery or primary endocrine therapy) and age and health status on BCSS. Missing data were handled using multiple imputation. RESULTS: Cancer registration data on 23 961 women were retrieved. After data preprocessing, 18 730 of 23 849 women (78·5 per cent) were identified as having ER-positive disease; of these, 10 087 (53·9 per cent) had surgery and 8643 (46·1 per cent) had primary endocrine therapy. BCSS was worse in the primary endocrine therapy group than in the surgical group (5-year BCSS rate 69·4 and 89·9 per cent respectively). This was true for all strata considered, although the difference was less in the cohort with the greatest degree of co-morbidity. For older, frailer patients the hazard of breast cancer death had less relative impact on overall survival. CONCLUSION: BCSS in older women with ER-positive disease is worse if surgery is omitted. This treatment choice may contribute to inferior cancer outcomes. Selection for surgery on the basis of predicted life expectancy may permit choice of women for whom surgery confers little benefit.

Part 1 behavioral science scores: after a summer psychiatric research clerkship: failure to replicate.

The present study did not replicate Holmes,' et al.'s (1987) findings that medical students who participated in a summer psychiatric research clerkship scored statistically significantly higher than matched controls on the Behavioral Science portion of the National Board of Medical Examiners' Part I Exam. Group ns in this replication were 39 each.

Clinical trainees' recollections of their training in a diagnostic preschool program: a pilot study.

26 clinician trainees' recollections of experiences in a diagnostic preschool program were analyzed in terms of strength and weaknesses of the program.

A comparison of Italian, Japanese and American students' responses to the Adolescent Reinforcement Survey Schedule.

The Italian form of the Adolescent Reinforcement Survey Schedule (ARSS-I) was administered to (N = 648) high school boys and girls from northern and central Italy. Their responses were factor analyzed using a principal component. VARIMAX rotation procedure (SAS Institute, Inc., 1990). The 10 interpretable factors from the Italian data were compared and contrasted to factor analytic results from Holmes (1991, 1994) studies using American and Japanese students. Additionally, the Italian data analyses includes an examination by gender using t tests for each of the ARSS-I items and an ANOVA for age and age-gender effects on responses to the ARSS-I.

An interim report on the development of the Psychological Trauma and Resources Scales.

The William S. Hall Psychiatric Institute Psychological Trauma and Psychological Resources Scales is a preliminary measure for the assessment of psychological trauma and psychological health from a developmental perspective. This three-part article (1) discusses the various rationales leading to the development of the scales, (2) provides a factor-analysis of responses of 336 college students, and (3) addresses current (N = 37) and planned efforts to establish reliability and validity of a more refined version.

Group intervention with second graders at risk for behavioral problems: a pilot study.

A 7-session-group intervention with four successfully adapting children and two with emerging behavior problems was conducted. Pre-posttest data showed reductions in teachers' ratings of externalizing behavior for each of the target children.

See no evil, hear no evil, speak no evil: why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?

This literature review explores the reasons why comparatively few adult males with a history of childhood sexual abuse are seen by professionals for help with difficulties relating to that abuse. Two potential explanations are discounted as myths-that relatively few males are sexually abused, and that abuse has little effect on males. However, it is suggested that society (including professionals and the victims themselves) has given credence to these myths. Male victims are relatively unlikely to disclose their experience of childhood abuse, and (as a coping strategy) they deny the impact of sexual abuse on their lives. Professionals fail to hypothesise that their male clients may have been abused, and do not create the conditions that would enable males to talk about the abuse. Blumer's (1971) model of the social construction of problems is applied to account for these beliefs and behaviours on the part of victims and clinicians. It is argued that the childhood sexual abuse of males has not yet acquired legitimacy as a problem recognised by society, thus lagging behind the abuse of females. In short, the "evil' of childhood sexual abuse in the male population is not being seen or heard by clinicians, and is not being recognised or talked about by victims. Clinical implications are considered.

Adolescent reinforcement survey schedule: summary of research and future directions.

Three completed studies with the Adolescent Reinforcement Survey Schedule are reviewed and further studies are discussed.

Japanese high school and college students' responses to the Adolescent Reinforcement Survey Schedule.

Factor-analyzed correlations among items of the Japanese Adolescent Reinforcement Survey Schedule by Japanese high school students (N = 939) and college students (N = 500) were compared to investigate the changes in reinforcers between mid- and late adolescence, gender differences, and the specific groupings of reinforcers which suggest certain interventions for either or both groups of adolescents. The factor analysis yielded ten interpretable factors in both groups. These factors were similar and did not suggest a dramatic shift in reinforcers between mid- and late adolescence. Items related to heterosexual activities and antisocial behaviors were rated as more pleasurable by males and items related to interpersonal relationships and academic activities were rated as more pleasurable by females. Since both groups of students attach high reinforcement value to interpersonal interaction with peers and family members, interventions focusing on social skills development might be popular and well attended.

A guided bibliography of the selective mutism (elective mutism) literature.

This guided bibliography of 122 articles on selective mutism covers nearly all of the English language publications on the topic. Index Medicus and Psychological Abstracts were the major source documents for the citations.

Behavior problems in preschool children: a pilot study.

Behavior problems in 20 preschool children (13 boys, 7 girls) referred to a diagnostic nursery were assessed using parents' ratings. The patterns of behavior problems reported in 4- and 5-yr.-olds parallel those noted for older clinic-referred children (i.e., internalizing difficulties in girls, externalizing difficulties in boys). The most salient behavior problems for 3-yr.-olds involved aggression. Correlations between children's behavior problems and an index of parents' experienced stress were moderate (.44 to .64).

Smoking habits in survivors of childhood and adolescent cancer.

Because of their increased risk for second cancers, childhood cancer survivors are people who really should not smoke, but available evidence suggests that they do. We studied the smoking habits of long-term childhood cancer survivors in data collected from 1289 adult survivors of childhood cancer and 1930 of their sibling controls. Survivors were diagnosed with cancer between 1945 and 1974 when they were less than 20 years old. Using matched analyses that controlled for the influence of family, survivors were 8% less likely than controls to be current smokers, 13% less likely to be ever-smokers, but 12% less likely to have quit smoking; these differences were not statistically significant. In a logistic regression analysis there was a significant difference by year of diagnosis for current smoking rate ratios (RR); survivors were less likely to be current smokers if diagnosed in recent years (RR = 0.76; 95% confidence intervals = 0.58-0.98, between 1965-74) and quite similar to controls if diagnosed in earlier years (RR = 1.05 between 1945 and 1954). In our group of long-term cancer survivors, the reduction in current smoking came about because survivors were more inclined never to start smoking than controls. Once addicted to tobacco, they were less likely to quit. While the fact that survivors are less likely to start smoking is encouraging, the persistence of smoking habits strongly suggests the need for continuing efforts to prevent smoking in this most vulnerable group.

Comparison of factor-analyzed Adolescent Reinforcement Survey Schedule (ARSS) responses from Japanese and American adolescents.

The Adolescent Reinforcement Survey Schedule (ARSS) was administered to a sample of male and female late adolescent college students from Japan (N = 500). The responses to the ARSS are factor analyzed using a principal component method. The results of the factor-analyzed ARSS from the Japanese sample are compared and contrasted with the results from a previous study (Holmes et al., 1987) in which ARSS was administered to a sample of American male and female college students (N = 231). Both the American and Japanese samples produced 10 interpretable factors. A recommendation is made to replicate the present study with groups of early and mid-adolescents in each culture in order to study shifts in reinforcers during different periods of adolescent development.

Evaluation of a predoctoral clinical psychology internship program by intern graduates.

This investigation is a replication and extension of an earlier study by Stout, Holmes, and Rothstein (1977) of the predoctoral clinical psychology intern graduates at the William S. Hall Psychiatric Institute. The interns were surveyed (N = 63) with regard to how adequately their internship experience prepared them for their current professional work as practicing clinical psychologists. Questionnaire data (n = 44) from graduates are analyzed in terms of the demographics of each intern's work situation, ratings of how well their internship prepared them in the areas of interprofessional relationships, teaching psychodiagnostic evaluations, psychological treatment, administration, consultation, and research. Several recommendations are offered by the intern graduates for refinement of the clinical psychology internship.

Behavioral science in medical education: a 1987-1991 bibliography.

Holmes, et al. in 1988 compiled 61 studies in an updated bibliography of behavioral science in undergraduate and graduate medical education. Since then, 64 additional studies of behavioral science in medical education have been published and abstracted in Index Medicus and Psychological Abstracts, the sources for the bibliography.

How recent medical school graduates evaluate the clinical relevancy of their behavioral science curriculum.

Recent graduates of the University of South Carolina School of Medicine (n=108) evaluated the clinical relevancy of their behavioral science curriculum. The results indicate that a body of behavioral science data are clinically relevant to physicians regardless of their specialty. Additional behavioral science content areas are clinically relevant for practitioners in particular medical specialties. Suggestions are made for the role of behavioral science material in continuing medical education.