Background The standard regimen of radiotherapy following lumpectomy consists of whole breast irradiation (WBI) to the entire breast including the lumpectomy cavity and all the surrounding normal breast tissue. Recently, there has been increased interest in partial breast irradiation (PBI) as an alternative to WBI. However, the preferences of patients with early breast cancer as to what type of radiotherapy regimen post lumpectomy they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI and to identify important factors for patients when making their treatment decision. Methods Based on our previous study of early stage breast cancer patient information needs, the relevant literature and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients with early breast cancer who were referred for adjuvant radiotherapy at the large academic cancer center were invited to participate. Women >40 years of age with a new histological diagnosis of ductal carcinoma in-situ or invasive breast carcinoma treated with breast conserving surgery showing clear margins for non-invasive and invasive disease and negative axillary nodes were eligible. Descriptive statistics were calculated for all variables of interest. Survey question responses were compared between those preferring WBI or PBI using chi-square analyses or Fisher's exact tests. Results Ninety /126 patients who were approached about this study completed the survey, 27(30%) preferred PBI and 55(62%) preferred WBI. Four patients (4%) required more information to choose between WBIvsPBI, and 3 patients (3%) had no preferences. From patients who choose WBI,32(58%)patients preferred hypofractionated RTvs 14 (25%)conventional RTregimen,Factors rated as important by patients in making their decision included convenience [PBI=18/26(69%), WBI=36/54(67%)], financial factors [PBI=14/26(53%), WBI=21/55(38%)], radiation dose to the breast [PBI=20/26(80%), WBI=46/55(83%)], invasiveness [PBI=18/26(69%), WBI=43/53(81%),, recurrence rate [PBI=26/26(100%), WBI=55/55(100%)], survival [PBI=26/26(100%),WBI=54/55(98%)], side effects PBI 21/26 (81%) WBI 47/55(85%) effectiveness [PBI=25/26(96%),WBI=54/54(100%)], standard method of treatment [PBI=16/26(61%), WBI=52/54(96%), p=0.001] and radiation dose to surrounding organs [PBI=23/26(88%), WBI=52/54(95%)]. Conclusions Our study shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. There is significant association between preference of treatment and importance of standard treatment. Patients preferring WBRT were more likely to consider standard treatment as more important than those preferring PBI.There was a marginally significant association between marital status and preference of radiotherapy(p=0.0773) and employment (p=0.0667).Those currently not employed were marginally more likely to prefer WBI than those currently employed. A detailed analysis of all decisional preferences between WBI and PBI will be presented at the meeting. Citation Format: Szumacher EF, McGuffin M, Presutti R, Pignol IP, Harth T, Mesci A, Feldman-Stewart D, Chow E, DiProspero L, Vesprini D, Rakovitch E, Lee J, Doherty M, Soliman H, Ackerman I, Cao X, Kiss A. Breast cancer patients' preferences for adjuvant radiotherapy post-lumpectomy: Whole breast irradiation versus partial breast irradiation-single institutional study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-10.
Introduction: Women over 70 are a growing demographic of breast cancer patients with specific needs requiring individualized care plans. We developed the interdisciplinary Senior Women's Breast Cancer Clinic (SWBCC) to improve access to a comprehensive geriatric assessment (CGA) and allied health services such as social work, occupational therapy, and pharmacy assistance. After initiation of the SWBCC, we conducted a pilot study using the VES-13 (vulnerable elders survey-13) tool to screen all patients over 70 with the goal of focusing referrals for patients who may benefit most from a CGA. The VES-13 was developed for community-dwelling elders and is validated in oncology patients. The objective of this study is to examine the outcomes of VES-13 screening, determine the medical issues identified by the CGA, and describe the development of this clinic. Methods: A retrospective review of the clinic from May 2015 - May 2017 was performed using the electronic medical records and paper screening forms. We separately describe the impact of the VES-13 to manage CGA referrals. A score of 3 or greater is a positive screen, and indicates the patient is at risk for death or decline. Non-parametric descriptive statistics were used for statistical analyses. Results: A total of 25 patients have been seen in the SWBCC for CGA to date. Median age was 83, (range 67-97). A median of two (range 1-4) new medical issues were identified from the CGA for each patient. The most common new diagnoses or issues identified were cognitive impairment (15/25), falls (6/25), neuropathy (4/25), and pain (4/25). The geriatric day program and falls prevention program were common referrals. After the introduction of VES-13 screening, a total of 54 patients were screened. Median age in that group was 78.5 years (range 70-95). The median VES-13 score was 1 (range 0-10). Of the 21 patients screened positive on VES-13, 7 went on to have a CGA. Of the remaining screen-positive patients, 3/21 patients declined SWBCC referral, and the others were not referred at the discretion of the physician. None of the patients with negative VES-13 were referred for CGA. The SWBCC structure was developed to utilize breast cancer-specific resources, whereby geriatricians provide consultation within the oncology space, and the allied health providers were affiliated with the breast centre. Oncology and geriatric administrative staff organized bookings to better coordinate schedules between the two disciplines. The geriatricians supervised trainees for the CGA, and follow-ups took place at SWBCC or in the geriatric outpatient clinic. Clinic coordinators affixed the VES-13 tool to all new patient charts for those aged ≥70. Nursing resources were dedicated to assist patients with VES-13 if needed, and document scores in the electronic medical record. Conclusions: A dedicated clinic for seniors with breast cancer providing geriatric assessment can identify important undiagnosed medical issues that warrant intervention or monitoring during breast cancer treatment. The VES-13 screening tool provides useful information to help manage resources for geriatrics referral. A prospective trial examining the role of CGA in decision-making for adjuvant chemotherapy is underway in this clinic. Citation Format: Menjak IB, Trudeau ME, Mehta R, McCullock F, Bristow B, Wright F, Rice K, Gibson L, Pasetka M, Szumacher EF. Pilot data from the development of the Senior Women's Breast Cancer Clinic at Sunnybrook Odette Cancer Centre [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-14.
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