Ultrahypofractionated Adjuvant Breast Radiation Therapy (± Boost) and Virtual Consultations: Patient Perspectives at 1 Year.

Purpose: In March 2020, a 1-week ultrahypofractionated adjuvant breast radiation therapy schedule, 26 Gy in 5 fractions, and telehealth were adopted to reduce the risk of COVID-19 for staff and patients. This study describes real-world 1-year late toxicity for ultrahypofractionation (including a sequential boost) and patient perspectives on this new schedule and telehealth workflows.

Methods And Materials: Consecutive patients were enrolled between March and August 2020.

Survival from breast cancer in women with a BRCA2 mutation by treatment.

Background: The impact of various breast-cancer treatments on patients with a BRCA2 mutation has not been studied. We sought to estimate the impact of bilateral oophorectomy and other treatments on breast cancer-specific survival among patients with a germline BRCA2 mutation.

Methods: We identified 664 women with stage I-III breast cancer and a BRCA2 mutation by combining five different datasets (retrospective and prospective).

Utilization of a breast cancer risk assessment tool by internal medicine residents in a primary care clinic: impact of an educational program.

Background: Despite strong evidence of benefit, breast cancer risk assessment and chemoprevention are underutilized by primary care physicians. This study evaluates the impact of an educational program on knowledge and utilization of the NCI Breast Cancer Risk Assessment Tool (BCRAT) by internal medicine residents.

Methods: Internal medicine residents at the primary care clinic at William Beaumont Hospital participated in an educational program on breast cancer risk assessment and chemoprevention.

Impact of preoperative BRCA1/2 testing on surgical decision making in patients with newly diagnosed breast cancer.

The utility and benefit of integrating germ-line genetic testing into the management of newly diagnosed breast cancer is not fully understood. This study evaluates the impact of preoperative genetic testing on surgical decision making in patients with newly diagnosed breast cancer. Women with newly diagnosed breast cancer were classified into preoperative or postoperative genetic testing group, depending on whether they received their genetic testing results prior to or after their first surgery.

Impact of BRCA Mutation Status on Survival of Women With Triple-negative Breast Cancer.

Introduction: The effect of germline BRCA mutations on the outcomes of patients with triple-negative breast cancer (TNBC) is not well understood.

Materials And Methods: The present retrospective study included women with newly diagnosed TNBC from January 1, 2004 to December 30, 2013. The demographic and tumor characteristics, genetic testing results, and outcomes were collected by a review of the patients' medical records.

Integrative medicine and the oncology patient: options and benefits.

Cancer is a major public health problem, and cancer patients and survivors face many physical and emotional challenges after the initial diagnosis, through treatment, and in the post-treatment period. Different integrative medicine (IM) modalities can be used to mitigate some of the physical issues that originate from the cancer itself or the treatment and to promote well-being and emotional health. Here, we discuss how an IM Department can function in a hospital system, particularly with regard to oncology patients, the modalities appropriate for oncology patients, how these modalities can benefit this patient population, and the role of IM in cancer survivorship.

Quantitatively Excessive Normal Tissue Toxicity and Poor Target Coverage in Postoperative Lung Cancer Radiotherapy Meta-analysis.

Background: A previous meta-analysis (MA) found postoperative radiotherapy (PORT) in lung cancer patients to be detrimental in N0/N1 patients and equivocal in the N2 setting. We hypothesized that treatment plans generated using MA protocols had worse dosimetric outcomes compared to modern plans.

Patients And Methods: We retrieved plans for 13 patients who received PORT with modern planning.

Preoperative genetic testing impacts surgical decision making in BRCA mutation carriers with breast cancer: a retrospective cohort analysis.

Background: The impact of timing of genetic testing on surgical decision making in women with breast cancer and mutation is not well known.

Methods: Women who were found to carry a deleterious mutation and had been diagnosed with breast cancer were identified from a database at Beaumont Health. Women who had received positive results at least a day prior to their index surgery were considered to be aware of their mutation status prior to surgery.

Squamous cell carcinoma of the breast in the United States: incidence, demographics, tumor characteristics, and survival.

Purpose: Squamous cell carcinoma of breast accounts for less than 0.1% of all breast cancers. The purpose of this study is to describe the epidemiology and survival of this rare malignancy.

A Health Profile of Arab Americans in Michigan: A Novel Approach to Using a Hospital Administrative Database.

The objectives of this study were to estimate and compare the prevalence of heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer's, diabetes, nephrosis, flu/pneumonia, hypertension, and atherosclerosis between Arab Americans and whites attending a large, metropolitan hospital system. The sample included 68,047 patients, 18 years of age or older, who visited the hospital during 2012. Demographic and disease variables were electronically abstracted.

Outcomes According to Breast Cancer Subtype in Patients Treated With Accelerated Partial Breast Irradiation.

Background: The purpose of the study was to determine outcomes for patients treated with accelerated partial breast irradiation (APBI) on the basis of breast cancer subtype (BCST).

Patients And Methods: Our single-institution, institutional review board-approved APBI database was queried for patients who had complete testing results for the estrogen (ER), progesterone (PR), and HER2/neu receptors to determine outcomes for each BCST. Women were assigned as luminal A (LA), luminal B (LB), HER2, and basal BCST using their ER, PR, and HER2/neu receptor status.

Comparison of Demographics, Tumor Characteristics, and Survival Between Pancreatic Adenocarcinomas and Pancreatic Neuroendocrine Tumors: A Population-based Study.

Objective: The objective of this study is to compare the incidence, demographics, tumor characteristics, and survival between patients with pancreatic neuroendocrine tumors (PNETs) and pancreatic adenocarcinomas.

Materials And Methods: Between 2004 and 2012, all cases of pancreatic adenocarcinomas and PNETs were extracted from the population-based cancer registries of the Surveillance Epidemiology and End Results program. To identify the cases, a combination of topographical and histology codes based on ICD-O-3 were used.

Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines.

Introduction: In this study, we compare the indications for re-excision, the findings of additional tumor in the re-excision specimen as they relate to margin status, and costs associated with re-excision based on recent new consensus statements.

Materials And Methods: A retrospective analysis was performed on 462 patients with invasive breast carcinoma who underwent at least one lumpectomy between January 2011 and December 2013. Postoperative data was analyzed based on where additional disease was found, as it relates to the margin status of the initial lumpectomy and the additional direct costs associated with additional procedures.

Early Results From the Implementation of a Lung Cancer Screening Program: The Beaumont Health System Experience.

Purpose: In 2010, a new study published by the National Lung Screening Trial showed a 20% reduction in mortality for those patients screened with low-dose computed topography (CT) versus x-ray. Recently, the Centers of Medicare and Medicaid have agreed to cover this service for those patients who meet the screening criteria. We compare the outcomes and costs associated with developing and implementing a lung cancer screening program.

Brachytherapy-based Accelerated Partial Breast Irradiation Provides Equivalent 10-Year Outcomes to Whole Breast Irradiation: A Matched-Pair Analysis.

Introduction: Although whole breast irradiation (WBI) represents the standard radiotherapy technique in breast conserving therapy, accelerated partial breast irradiation (APBI) has emerged as an option to reduce treatment duration with comparable clinical outcomes. The purpose of this analysis is to present long-term clinical outcomes between WBI and APBI.

Methods: A total of 3009 patients were treated with breast conserving therapy at a single institution between 1980 and 2012.

Lymphedema care for the breast cancer patient: an integrative approach.

Lymphedema is a serious complication that involves the accumulation of protein-rich fluid in the interstitial space. Lymphedema is common after treatment for breast cancer, especially for those patients receiving axillary lymph node dissection. Severe lymphedema is associated with serious morbidities such as swelling, fibrosis, decreased function, reduced range of motion, infection, and pain.

Implementation of an oncology exercise and wellness rehabilitation program to enhance survivorship: the Beaumont Health System experience.

We developed a multidisciplinary approach to oncology rehabilitation by setting up a physical therapy screening program in a dedicated multidisciplinary clinic to improve survivorship care in the community oncology setting. In June 2011, an oncology rehabilitation program was launched as part of the overall survivorship program to provide patients with an introduction to cancer services, consultation with multiple clinicians, education about their diagnoses, and recommendation for rehabilitation services during or after treatment. The consultation was in conjunction with specialists at the multidisciplinary clinics that were already established within the organization.

Impact of the number of cautionary and/or unsuitable risk factors on outcomes after accelerated partial breast irradiation.

Purpose: To examine clinical outcomes of accelerated partial-breast irradiation (APBI) stratified by the number of American Society for Radiation Oncology consensus statement cautionary/unsuitable risk factors (RFs) present.

Methods And Materials: A total of 692 patients were treated with APBI at a single institution between April 1993 and January 2012 using interstitial (n=195), balloon (n=292), and 3-dimensional conformal radiation therapy (n=205) techniques. Clinical outcomes were evaluated by risk group and number of RFs.

Cost-effectiveness of 3-dimensional conformal radiotherapy and applicator-based brachytherapy in the delivery of accelerated partial breast irradiation.

Purpose: To compare reimbursement and cost efficacy between accelerated partial breast irradiation (APBI) techniques.

Materials/methods: Four hundred fifty-three patients were treated with APBI using either 3-dimensional conformal radiotherapy (3D-CRT, n=207) or balloon-based brachytherapy (BB) [single-lumen (SL, n=161) and multilumen (ML, n=85)] between March 2000 and October 2011. To evaluate cost-effectiveness, reimbursement by treatment technique was calculated based on 2011 Medicare schedules.

Use of intensity modulated radiation therapy to reduce acute and chronic toxicities of breast cancer patients treated with traditional and accelerated whole breast irradiation.

Purpose: The purpose of this analysis was to examine the impact of applying intensity modulated radiation therapy (IMRT) on toxicity with traditional and accelerated whole breast irradiation (AWBI).

Methods And Materials: A total of 335 patients with stage 0-IIB breast cancer were treated with either a conventional wedge technique (S-WBI, n = 87), IMRT (I-WBI, n = 93), or AWBI with IMRT (I-AWBI, n = 155). S-WBI and I-WBI patients received a median dose of 45 Gy to the breast with a median 16-Gy tumor bed boost for a cumulative median dose of 61 Gy.

Clinical outcomes using accelerated partial breast irradiation in patients with ductal carcinoma in situ.

Background: Limited data exist on the use of accelerated partial breast irradiation (APBI) in patients with ductal carcinoma in situ (DCIS). The purpose of this analysis was to evaluate clinical outcomes after APBI in patients with DCIS.

Patients And Methods: Between December 2002 and December 2010, 99 patients with DCIS underwent APBI as part of their breast-conserving therapy (BCT).

Twenty-year outcomes after breast-conserving surgery and definitive radiotherapy for mammographically detected ductal carcinoma in situ.

Background: Management of mammographically detected ductal carcinoma in situ (DCIS) at a single institution was reviewed to determine long-term clinical outcomes after treatment with breast-conserving therapy (BCT).

Methods: Data from all patient-cases with DCIS who received BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for their effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival.

Implementation and outcomes of a multidisciplinary high-risk breast cancer program: the William Beaumont Hospital experience.

Unlabelled: Limited data are available on the implementation of a high-risk assessment program in the construct of a community clinical oncology program. The development of a high-risk breast cancer screening program at our institution identified 15%-20% of patients screened as high risk, with limited increases in structural or personnel requirements. Identification of patients as high risk could potentially improve outcomes by allowing for individualized prevention strategies and more appropriate high-risk surveillance.