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.
Background: Discordance in tumor receptor status between primary and recurrent tumors has been previously reported. Discordant ER/PR status has been used to differentiate recurrences from new primaries. We evaluated discordance rates of ER and PR expression between the primary and locoregional/contralateral recurrences and examined the relationship with adjuvant endocrine therapy (ET). Methods: We conducted a retrospective chart review of breast cancer patients (pts) treated with lumpectomy and adjuvant locoregional radiation (RT) from 1999-2005 at the Princess Margaret Cancer Centre. Tumor recurrence was classified as locoregional recurrence (LRR) for ipsilateral breast or lymph node recurrence, contralateral disease (CD) or distant recurrence. ER and PR were assessed by immunohistochemistry; positive if >10% tumor cells staining, borderline if 10% staining, and negative if <10% staining. Univariate analyses were applied to determine the association of receptor discordance with age, menopausal status, tumor grade, endocrine therapy or adjuvant chemotherapy. Results: All 441 pts had a lumpectomy with negative margins and RT, and had a median follow-up of 8.3 years. The median age at primary surgery was 57, and 67% of pts were postmenopausal. ET (tamoxifen and/or aromatase inhibitors) was initiated in 294 (84%) eligible patients. There were 24 (5.4%) pts with LRR, 20 (4.5%) pts with CD, and 28 (6.3%) with distant metastases. Nine pts with LRR also had distant disease, and 3 pts with CD also had distant disease. Among pts with LRR, 17 had ER/PR status available for comparison. Discordance rates for ER and PR were (1/17) 5.9% and (3/17) 17.6%, respectively, and the most common change was ER becoming positive, and PR becoming negative (75%). For pts with CD, 18 had ER/PR status available for comparison. Discordance rates for ER and PR were (7/18) 38.9% and (9/18) 50%, respectively. The most common change was ER becoming positive (86%), and PR becoming positive (75%). Distant disease receptor status was only available for two patients, therefore not included. The patient with LRR and discordant ER did not receive ET, while pts with LRR and discordant PR all received ET. Among patients with CD, 15% of patients with discordant ER status received ET, and 33% with discordant PR received ET. There was no statistically significant association between discordance rates in either LRR or CD groups and use of ET. Similarly, discordance rates were not associated with the other patient or tumor variables studied, or the development of distant metastases or death. Conclusions: Discordance of ER and PR expression was low in LRR and higher in CD, where the majority of changes were from negative to positive receptor status. Receptor discordance was not associated with endocrine therapy. This study suggests that the biology of LRR and CD may be different, and re-evaluation of receptor status could lead to additional treatment options becoming available from an endocrine standpoint. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-13-14.
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