Both experimental arms demonstrated activity, with a PFS of >5 months. However, the addition of everolimus to CPB failed to improve outcomes, with increased toxicity noted. These findings replicate the moderate antitumor activity of CPB, with future development possibly in combination with targeted or immunotherapy. Cancer 2018;124:537-45. © 2017 American Cancer Society.
ImportancePhysician parents, particularly women, are more likely to experience burnout, poor family-career balance, adverse maternal and fetal outcomes, and stigmatization compared with nonparent colleagues. Because many physicians delay child-rearing due to the rigorous demands of medical training, favorable parental leave policies for faculty physicians are crucial to prevent physician workforce attrition.ObjectiveTo evaluate paid and unpaid parental leave policies at medical schools ranked by US News & World Report in 2020 and identify factors associated with leave policies.Design, Setting, and ParticipantsThis cross-sectional national study was performed at US medical schools reviewed from December 1, 2019, through May 31, 2020, and February 1 through March 31, 2021, due to the COVID-19 pandemic. All medical schools ranked by US News & World Report in 2020 were included.Main Outcomes and MeasuresThe primary outcome was the number of weeks of paid and unpaid leave for birth, nonbirth, adoption, and foster care physician parents. Institutional policies for the number of weeks of leave and requirements to use vacation, sick, or disability leave were characterized. Institutional factors were evaluated for association with the duration of paid parental leave using χ2 tests.ResultsAmong the 90 ranked medical schools, 87 had available data. Sixty-three medical schools (72.4%) had some paid leave for birth mothers, but only 13 (14.9%) offered 12 weeks of fully paid leave. While 11 medical schools (12.6%) offered 12 weeks of full paid leave for nonbirth parents, 38 (43.7%) had no paid leave for nonbirth parents. Adoptive and foster parents had no paid leave in 35 (40.2%) and 65 (74.7%) medical schools, respectively. Median paid parental leave was 4 (IQR, 0-8) weeks for birth parents, 4 (IQR, 0-6) weeks for adoptive parents, 3 (IQR, 0-6) weeks for nonbirth parents, and 0 (IQR, 0-1) weeks for foster parents. About one-third of medical schools required birth mothers to use vacation (29 [33.3%]), sick leave (31 [35.6%]), or short-term disability (9 [10.3%]). Among institutional characteristics, higher ranking (top vs bottom quartile: 30.4% vs 4.0%; P = .03) and private designation (private vs public, 23.5% vs 9.4%; P < .001) was associated with a higher rate of 12 weeks of paid leave for birth mothers.Conclusions and RelevanceIn this cross-sectional national study of medical schools ranked by US News & World Report in 2020, many physician faculty receive no or very limited paid parental leave. The lack of paid parental leave was associated with higher rates of physician burnout and work-life integration dissatisfaction and may further perpetuate sex, racial and ethnic, and socioeconomic disparities in academic medicine.
Background Accurate diagnostic biomarker testing is crucial to treatment decisions in breast cancer. Biomarker testing is performed on core needle biopsies (CNB) and is often repeated in the surgical specimen (SS) after resection. As differences between CNB and SS testing may alter treatment decisions, we evaluated concordance between CNB and SS as well as associated changes in treatment and clinical outcomes. Methods We performed a retrospective analysis of breast cancer patients at our institution between January 2010 and May 2020. Concordance between CNB and SS was assessed for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Survival in patients, including recurrence, metastatic recurrence, and death, were assessed using chi‐squared likelihood ratio. Results In total, 961 patients met eligibility criteria. Concordance, minor discordance, total concordance (concordance plus minor discordance), and major discordance between CNB and SS were reported for ER (87.7%, 9.2%, 90.8%, and 2.9%), PR (58.1%, 29.1%, 87.2%, and 12.8%), and HER2 IHC (52.5%, 20.9%, 73.4%, 26.6%), respectively. HER2 FISH concordance and major discordance were 58.5% and 1.2%, respectively. Of major discordance, ER (48.2%, p < 0.001) and HER2 FISH (50.0%) led to more management changes than HER2 IHC (2.4%, p = 0.04) and PR (1.6%, p = 0.10). Patients with ER major discordance had increased risk of death (6.7% concordance vs. 22.2% major discordance, p = 0.004). Conclusion Overall, retesting ER and HER2 was more clinically beneficial than retesting PR. To aid decision‐making and minimize healthcare costs, we propose patient‐centered guidelines on retesting biomarker profiles.
Gestational breast cancer (GBC) is the most common form of invasive cancer in pregnancy and has unique challenges in both staging and treatment given the dual goal of appropriate cancer management and minimising the risk of fetal toxicity. A 38-year-old woman with no significant medical history and 21 weeks pregnant presented with a palpable right breast mass. She was diagnosed with human epidermal growth factor receptor 2-positive infiltrating ductal carcinoma with advanced disease. The patient underwent treatment; however, unfortunately, she passed away after developing devastating distant disease recurrence.We highlight both the challenges and current guidelines for management of GBC. Our goal is to discuss the current limitations of GBC management and the necessity of further investigation for safe novel imaging and treatment modalities for pregnant women. It is crucial to increase awareness across multiple subspecialities, as a multidisciplinary team is necessary for proper treatment of GBC.
Objective: To evaluate the prognostic significance of detectable circulating cell-free DNA (cfDNA) BRAF V600E/K mutations in patients with advanced melanoma enrolled in a clinical trial without BRAF-targeted therapy.Patients and Methods: BRAF V600E/K mutation status was determined on archived tissue and pretreatment stored plasma from 149 patients with unresectable stage IV melanoma who were enrolled between May 5, 2010 and May 2, 2014 in the North Central Cancer Treatment Group/Alliance N0879 randomized phase 2 clinical trial. Results were reported as presence or absence of cfDNA BRAF V600E/K detection of assay vs tissue. Progression-free survival (PFS) and overall survival (OS) were assessed for patients with and without detectable BRAF mutation. Results: In total, 63 of 149 (42.3%) patients had BRAF V600E/K results for tissue and blood, and 20 of 63 (31.7%) patients had tissue-diagnosed mutant BRAF. Of these, 11 of 20 (55.0%) patients had detectable plasma cfDNA BRAF. Among patients with tissue-mutant BRAF V600E/K, PFS and OS were shorter for those with corresponding cfDNA mutations (PFS, 5.8 vs 12.0 months; P¼.051; OS, 9.2 vs 27.1 months; P¼.054). Our assay demonstrated sensitivity of 55% (95% CI, 0.322 to 0.768), specificity of 97.7% (95% CI, 0.932 to 1.000), positive predictive value of 91.7% (95% CI, 0.760 to 1.000), and negative predictive value of 82.4% (95% CI, 0.719 to 0.928). Conclusion:In advanced melanoma, detectable cfDNA BRAF V600E/K mutation is present in about half the patients with stage IV with BRAF-mutant melanoma tumor tissue and appears to confer a poorer prognosis when detectable. Given the poorer prognosis, cfDNA can be used to risk-stratify patients with metastatic melanoma in practice or clinical trials. Trial Registration: clinicaltrials.gov Identifier: NCT00976573
Introduction: Hospitalization-associated VTE attack (incident plus recurrent VTE) rates over the 6-year period, 2005-2010, did not change significantly despite achieving near-universal in-hospital VTE prophylaxis; 75% of these VTE events occurred after hospital discharge with a median of 19.5 days from hospital discharge to VTE. The median durations of hospitalization and in-hospital prophylaxis were 3 days and 70 hours, respectively, suggesting that VTE prophylaxis was inadequate. However, the hospital population that would benefit most from post-hospitalization VTE prophylaxis is uncertain. Our study aim was to test hospital length of stay (LOS) as a potential predictor of post-hospital-discharge incident or recurrent VTE. Methods: Using the resources of the Rochester Epidemiology Project, we identified all unique Olmsted County, MN residents hospitalized at least once at a Rochester, MN Mayo Clinic hospital and all such residents with objectively-diagnosed occurrence of first or recurrent VTE during hospitalization or within 92 days after hospital discharge, 2005-2010. We tested LOS as a potential predictor of post-hospital-discharge VTE (conditional on surviving to hospital discharge free of VTE) using the Anderson-Gill version of Cox regression modeling and adjusting for age, sex, any surgery performed during that hospitalization, and Charlson Comorbidity Index calculated from conditions recorded from 1/1/2005 until the day of hospital discharge. Results: Over the period, 2005-2010, 31,588 unique Olmsted County residents were hospitalized at least once at a Rochester Mayo Clinic hospital. The distribution of LOS was: 1-2 (3.8%), 3 (24.2%), 4 (23.3%), 5 (16.4%), 6 (8.8%), 7-9 (12.4%), 10-19 (8.4%) and 20+ (2.3%). Of the 253 VTE events identified within 92 days post-hospital discharge, 6, 29, 31, 38, 38, 53, 42 and 16 had been hospitalized for 1-2, 3, 4, 5, 6, 7-9, 10-19 and 20+ days, respectively. The hazard ratios (HR) for post-hospital-discharge VTE were similar for hospital LOS ≤4 days; compared to LOS ≤3 days, the HRs were significantly increased for hospital LOS of 5 (HR=1.78), 6 (HR=2.86), 7-9 (HR=2.71), 10-19 (HR=3.16) and 20+ (HR=4.20) days (Table 1). Conclusions: The adjusted hazards of post-hospital discharge VTE for hospital LOS > 4 days were significantly increased 1.8 to 4.2-fold compared to LOS ≤3 days, suggesting that hospital LOS may be useful for identifying hospitalized patients suitable for longer duration VTE (including post-discharge) prophylaxis. Future studies should be aimed at identifying additional predictors of post-hospital-discharge VTE such that extended prophylaxis can be targeted to those patients who would benefit most. Disclosures No relevant conflicts of interest to declare.
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