Outcomes for Patients with Residual Stage II/III Breast Cancer Following Neoadjuvant Chemotherapy (AFT-01).

INTRODUCTION: Pathologic complete response (pCR) after neoadjuvant chemotherapy has a demonstrated survival advantage; however, outcomes for non-pCR by receptor status are less understood. We sought to evaluate survival and distant recurrence by receptor status for patients with residual stage II/III breast cancer. METHODS: A stage-stratified random sample of 11,366 patients with stage II-III breast cancer in 2006-2007 was selected from 1217 facilities in the National Cancer Database for a Commission on Cancer Special Study. We identified patients with residual pathologic stage II/III cancer who received standard of care therapy based on receptor status. Distant recurrence and 5-year survival were abstracted and Kaplan-Meier curves were generated by receptor status. Multivariable Cox regression was used to estimate hazard ratios for death and distant recurrence. RESULTS: A total of 734 patients had residual disease; 58%, 28%, and 14% were ER or PR+/Her2neu-, ER and PR-/Her2neu-, and Her2neu+ (any ER/PR), respectively. ER and PR-/Her2neu- cancers had the poorest 5-year overall (52% vs. 82% for Her2neu+ and ER or PR+/Her2neu-, p < 0.0001) and distant recurrence-free survival (57% vs. 72% Her2neu+ and 77% ER or PR+/Her2neu, p < 0.0001). Cox regression models demonstrated a higher likelihood of distant recurrence and death for patients with ER and PR-/Her2neu- disease (HR 2.25, 95% CI 1.56-3.24 and HR 3.19, 95% CI 2.20-4.64 respectively) compared with ER or PR+/Her2neu-. CONCLUSIONS: Patients with residual ER and PR-/Her2neu- cancer have a significant risk of distant recurrence and mortality compared with other breast cancer types, supporting the consideration for additional adjuvant therapy and novel clinical trials in this cohort. Trial registry number ClinicalTrials.gov identifier NCT02171078.

Breast cancer survivor's perspectives on the role different providers play in follow-up care.

IMPORTANCE: Significant variation in the number and types of oncologists that provide breast cancer follow-up exists. However, there is limited understanding regarding breast cancer survivors' preferences for who provides their follow-up. Our objective was to explore breast cancer survivors' perspectives on the goals of breast cancer follow-up, the preferred role for primary care providers, and the perceived roles of different types of oncologists during follow-up. METHODS: A convenience sample of stage 0-III breast cancer survivors was identified and in-depth one-on-one interviews conducted. Data were analyzed using inductive content analysis. RESULTS: Survivors cited a strong preference for oncology-based follow-up within the first 5 years after diagnosis, driven by their need for reassurance that cancer had not recurred. Survivors also thought that their primary care provider needed to be involved. Survivors assumed that oncology follow-up was directed by a standard protocol that included streamlining the follow-up team. Survivors recognized that patients with more complex cancers or challenging treatment courses may require more intensive follow-up and deviate from the standard protocol. Most survivors were comfortable deferring decisions regarding who participated in follow-up to the oncology team. CONCLUSIONS: Most patients think a streamlined approach to oncology-based breast cancer follow-up already occurs, driven by a standard protocol. The use of a standard protocol to provide guidance for which types of oncology providers should participate in breast cancer follow-up will streamline care and represents a significant opportunity to reduce unnecessary variation. This approach is especially critical given patients' strong preferences for oncology-based follow-up.

Colon Cancer Staging in Vulnerable Older Adults: Adherence to National Guidelines and Impact on Survival.

BACKGROUND: There is concern that elders are not adequately evaluated prior to colon cancer surgery. We sought to determine adherence with ACOVE-3 (Assessing Care of Vulnerable Elders) quality indicators for pre-operative staging prior to colectomy for colon cancer utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (1992-2005). METHODS: We determined the proportion of patients aged 75 and older who had preoperative staging prior to colectomy for colon adenocarcinoma. Preoperative staging was defined as abdominopelvic computed tomography or magnetic resonance imaging scan (SCAN) and colonoscopy or flexible sigmoidoscopy (SCOPE). Multivariate logistic regression identified predictors of adherence. Odds ratios were adjusted for comorbidity, socioeconomic status, and disease severity. The association of adherence to ACOVE-3 and survival was quantified. RESULTS: Of the 37,862 patients, the majority were 75-84 years, 28% of the patients were ≥85 years. Regarding preoperative staging in the 6-month interval prior to surgical resection, 8% had neither SCAN nor SCOPE, 6% had only SCAN, 43% had only SCOPE, and 43% had both SCAN and SCOPE. Compared to patients who were not staged, those evaluated with either SCOPE alone or SCAN plus SCOPE had lower odds of 3-year mortality. Patients who were staged with SCAN alone had an increased odds of death compared to those who had neither SCAN or SCOPE. CONCLUSIONS: These data demonstrate that the majority of vulnerable elders with colon cancer did not receive appropriate preoperative staging prior to resection. The findings also confirm that adherence to ACOVE-3 guidelines is associated with improved long-term survival.

Trends in motor vehicle deaths in Wisconsin, 1986-1996: a decade of progress?

Motor vehicle-related injuries are a major cause of death and economic burden in Wisconsin. We examined motor vehicle-related mortality trends in Wisconsin from 1986 to 1996. During this time, overall mortality decreased by 12% and Wisconsin has met its year 2000 goal. However, mortality rates did not improve for women and non-whites. In addition, mortality rates increased in persons over 75 years. There are several explanations that may account for the overall mortality rate decline, but the reasons for the differences between age, racial, and gender groups are unclear.

Cystic nasal concha in a calf.

Unilateral cystic nasal concha was diagnosed in a 6-month-old Brangus male calf by use of endoscopy, radiography, and histologic examination. Cystic nasal conchae have been excised via dorsolateral rhinotomy, but the lesion in the calf of this report was excised transnasally, with considerable ease, using obstetric wire. Postoperative complications did not develop, and the calf was reportedly in good health 3 months after discharge.

Do different doses of intravenous streptokinase alter the frequency of coronary reperfusion in acute myocardial infarction?

This study assessed the relative efficacy of 3 doses of intravenous streptokinase in causing hypofibrinogenemia and coronary reperfusion in patients with acute myocardial infarction. Accordingly, 56 patients (50 men and 6 women, ages 58 +/- 10 years [mean +/- standard deviation]) with evolving acute myocardial infarction and chest pain less than or equal to 5 hours in duration were assigned to receive varying doses of streptokinase. Twenty were administered 500,000 units during 145 minutes, 18 were given 750,000 units during 30 minutes and 18 received 1.5 million units in 60 minutes of streptokinase. Serum creatine kinase was measured on admission and 6, 12, 18 and 24 hours after the initiation of streptokinase. The time intervals from onset of pain to peak creatine kinase and from streptokinase administration to peak creatine kinase were used to determine the occurrence of reperfusion. The plasma fibrinogen concentration was measured 30, 60, 90 and 120 minutes after the initiation of streptokinase. For the 3 groups, the time from onset of pain to peak creatine kinase was less than 17 hours and the time from streptokinase to peak creatine kinase was 6 or 12 hours in 15 (75%), 16 (89%) and 12 patients (67%), respectively (differences not significant). The plasma fibrinogen concentration decreased to 45 +/- 34 mg/dl, 19 +/- 14 mg/dl and 29 +/- 43 mg/dl, respectively, during the 2 hours after streptokinase was begun (p less than 0.05 for the first versus the second and third values).(ABSTRACT TRUNCATED AT 250 WORDS)

Reevaluation of the role of T-mycoplasmas in nongonococcal urethritis.

T-mycoplasmas have been associated with nongonococcal urethritis (NGU) in studies in which these organisms were found to be more prevalent among men with NGU than among control groups of men. In none of these studies were the groups matched for sexual experience, a variable which we have shown to be an important determinant of colonization with T-mycoplasmas. We obtained urethral cultures for genital mycoplasmas from men presenting to the Boston City Hospital with gonococcal urethritis and with NGU, and from men of comparable sexual experience who did not have urethritis. Colonization with T-mycoplasmas was no more prevalent among men who had NGU than among the men who did not have urethritis. These data raise some serious questions about the role of T-mycoplasmas in nongonococcal urethritis.

Comparison of methods for the isolation of genital mycoplasmas from men.

Two hundred nine men were studied to determine the optimal method of obtaining cultures for genital mycoplasma. Ureaplasma urealyticum (T-mycoplasmas) was isolated from 95 (45.5%) of the participants. Urethral cultures obtained by means of urethrogenital calcium alginate swabs identified 82 (86%) of the 95 colonized men. Urethral cultures taken with cotton-tipped applicators (76%) urine cultures (27%), and cultures of the coronal sulcus (24%) detected fewer colonized men. All men who were colonized with U. urealyticum were identified by one of the two urethral cultures. Mycoplasma hominis was recovered from 73 (34.9%) of the 209 men. Urethral cultures identified most of the circumcised men who were colonized with M. hominis (11 of 14; 79%). In contrast, cultures from the coronal sulcus detected most of the colonized uncircumcised men (49 of 59; 83%). More than 90% of the men who were colonized with M. hominis were identified by either urethral culture or culture of the coronal sulcus. A similar study was conducted among 143 normal college students yielded comparable results.