Little research has examined the impact of cancer and chemotherapy treatment for breast cancer from men's perspectives as partners, fathers, and caregivers. This research, part of a larger study describing women's, partners', and children's perspectives, aims to describe men's perspectives on their experiences and how their wives' breast cancer and chemotherapy impacted them and their families, to describe what facilitated and hindered their coping, and to suggest interventions to assist men and their families to manage the experience with less stress. This participatory action study used qualitative naturalistic inquiry methods. Semistructured interviews were conducted with 11 male partners. Two major themes were identified: focusing on a wife's illness and care, and focusing on the family to keep life going. Nine sub-themes cut across the major themes: being there, relying on health care professionals, being informed and contributing to decision making, trying to keep patterns normal and family life going, helping out and relying on others, being positive, putting self on hold, adapting work life, and managing finances.

Background: Neutropenic complications including severe and febrile neutropenia (FN) represent major dose-limiting toxicities of cancer chemotherapy. A general risk model for neutropenic complications across major solid tumors has been developed and validated (Lyman et al. Cancer 2011). Current guidelines recommend consideration of primary prophylaxis with a colony-stimulating factor (CSF) in patients at >20% risk of FN. The decision for primary CSF prophylaxis in patients on intermediate risk chemotherapy (10-20%) is based on physician assessment of individual patient risk factors for FN. This study assesses the ability of this general FN risk model to identify ESBC patients on intermediate risk chemotherapy who are at a personal high risk for developing a neutropenic complication. Methods: A prospective cohort study accrued 4458 consenting patients starting a new chemotherapy regimen at 115 randomly selected community oncology practices throughout the United States from 2002–2006. The risk of severe or febrile neutropenia (SNFN) in cycle 1 and across 4 cycles was estimated [±95% CI] utilizing logistic regression analysis and adjusting for key clinical factors including among others: age, prior chemotherapy, abnormal hepatic or renal function, low pretreatment white blood count, immunosuppressive medications, CSF prophylaxis, and planned relative dose intensity as well as major chemotherapeutic agents. The cumulative risk of FN across 4 cycles was also estimated by the product limit method of Kaplan and Meier. Results: Among 1224 patients with ESBC, 822 received intermediate risk chemotherapy based on National Comprehensive Cancer Network guidelines. Among these patients, cycle 1 SNFN occurred in 37%, at least one episode of FN over 4 cycles of chemotherapy in 17%, with 15% receiving primary CSF prophylaxis. The predicted risk of cycle 1 SNFN ranged from 1%-79%, with mean (median) risk of 33.8% (39.0%). Model performance was good with a c-statistic of 0.73 [0.69−0.76]. Based on this general FN risk model, cycle 1 SNFN occurred in 47% of predicted high risk ESBC patients [42 — 52%] compared to 13% [8-17%] of low risk patients. One or more FN events over 4 cycles occurred in 20% [17-24%] of predicted high risk versus 10% [6-14%] in low risk patients. The cumulative risk of FN by Kaplan-Meier estimation was 23% in high risk and 10% in low risk patients. Model sensitivity and specificity for FN were 83% and 33%, respectively. The majority of SNFN (76%) and FN (58%) events among high risk patients occurred in cycle 1. 50% of high risk patients who did not receive primary CSF prophylaxis went on to receive CSF during subsequent cycles. Conclusions: Based on good test performance characteristics, this clinical FN prediction model also identifies ESBC patients receiving intermediate risk chemotherapy at high personal risk for FN (FN >20%) over the first 4 cycles of chemotherapy. Half of predicted high risk patients without primary CSF prophylaxis will be given CSF in subsequent cycles after the occurrence of a neutropenic complication. This also confirms previous clinical trial findings that the majority of febrile neutropenic events occur in the first cycle. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-20-03.

No abstract

Background: Febrile neutropenia (FN) represents a major dose-limiting toxicity of cancer chemotherapy resulting in considerable morbidity, mortality, and cost. Patients have the highest risk of the initial neutropenic event in cycle 1 when most patients receive full dose chemotherapy. This study evaluates time course of neutropenic events in patients receiving chemotherapy for early-stage breast cancer (ESBC) and supportive care interventions that modify FN risk in ESBC patients treated in actual oncology practice. Methods: A prospective cohort study of adult cancer patients with solid tumors or lymphoma starting a chemotherapy regimen was conducted at 115 U.S. sites. Toxicities associated with chemotherapy were recorded in up to 4 cycles including severe neutropenia (SN), FN, and infection. Documented clinical interventions included reductions in chemotherapy relative dose intensity (RDI), the use of colony-stimulating factors (CSFs), and antibiotics. Results: A total of 1202 ESBC patients starting chemotherapy were analyzed, of which 1154, 1099, and 896 reached the midcycle of cycles 2, 3, and 4, respectively. While the majority of neutropenic and infection events occurred in cycle 1, decreasing rates of FN and infection in later cycles correlated with increasing reductions in dose intensity and increased use of CSFs and antibiotics. The overall risk of FN in all patients combined was 16.3 %. It reached 21.1% for patients who started with planned RDI≥85% and without primary CSF prophylaxis. There was no significant difference in FN rates by menopausal status or hormone receptors. Conclusions: While the risk of neutropenic complications is highest during the first cycle of chemotherapy, reductions in neutropenic events during subsequent cycles are associated with reduced chemotherapy dose intensity or increased use of supportive care measures. Nevertheless, the cumulative risk of neutropenic events remains high in ESBC patients receiving full dose chemotherapy without prophylactic measures overall and across menopausal and hormone receptor subgroups. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-15-04.

A 3 4 7 -A 7 6 6 radiotherapy. Methods: German physicians completed a web-based medical record review for patients ≥ 18 years old who had received ≥ 1 line of systemic therapy for advanced STS (other than Kaposi's sarcoma or gastrointestinal stromal tumors) between 1/1/2005 and 20/2/2014. Physicians reported patients' clinical characteristics, treatments and outcomes. Data were summarized overall, by line of therapy, and for histological subtypes. Results: Forty physicians (primarily practicing in academic hospitals (58%) or cancer centers (28%)) provided data for 204 patients. Physicians reported that 10% (median) of the patients in their practices with advanced STS did not receive any systemic cancer-directed therapy and were thus ineligible for this study. Patients' mean age at advanced STS diagnosis was 57.4 (SD= 11.0) years, and 64% were male. The most frequent histologic subtypes were leiomyosarcoma (32%), liposarcoma (11%), and rhabdomyosarcoma (10%). Seventyseven percent of patients had stage IV STS at initial diagnosis; the remainder progressed in an average of 23 (SD= 23) months. Forty percent of patients had > 1 and 6% had > 2 lines of therapy. The five most frequent first-line chemotherapy regimens were doxorubicin (53%), doxorubicin/ifosfamide/mesna (17%), docetaxel/gemcitabine (13%), paclitaxel (4%), and dacarbazine/ifosfamide/mesna (3%); in second-line they were ifosfamide/mesna (41%), docetaxel/gemcitabine (20%), pazopanib (15%), doxorubicin (9%), and trabectedin (5%). During first-line treatment, response rate was an average of 39%, with the highest rate for patients receiving dacarbazine/ifosfamide/mesna (50%; N= 6) and the lowest rate for paclitaxel users (13%; N= 8). Median survival estimates from start of first-and second-line therapy were 13 (Q1:Q3= 8:31) and 19 (Q1:Q3= 11: Q3 not estimable) months, respectively. ConClusions: Results from this retrospective medical record review point to modest differentiation among existing therapies and a need for further improvements in advanced STS treatment options in Germany. PCN287 Skeletal-Related eveNtS (SReS) aNd ReNal FuNCtioN iN PatieNtS withSymPtomatiC multiPle myeloma (mm): ReSultS FRom Belgium, FRaNCe, geRmaNy, italy, SPaiN, SwitzeRlaNd aNd the uNited kiNgdom