This study describes patient social networks within a new hemodialysis clinic and models the association between social network participation and kidney transplantation. Survey and observational data collected between August 2012 and February 2015 were used to observe the formation of a social network of 46 hemodialysis patients in a newly opened clinic. Thirty-two (70%) patients formed a social network, discussing health (59%) and transplantation (44%) with other patients. While transplant-eligible women participated in the network less often than men (56% vs. 90%, p = 0.02), women who participated discussed their health more often than men (90% vs. 45.5%, p = 0.02). Patients in the social network completed a median of two steps toward transplantation compared with a median of 0 for socially isolated patients (p = 0.003). Patients also completed more steps if network members were closely connected (β = 2.23, 95% confidence interval [CI] 0.16-4.29, p = 0.03) and if network members themselves completed more steps (β = 2.84, 95% CI 0.11-5.57, p = 0.04). The hemodialysis clinic patient social network had a net positive effect on completion of transplant steps, and patients who interacted with each other completed a similar number of steps.
Highlights
No partial or complete responses to pembrolizumab and lenvatinib therapy were observed in advanced or recurrent UCS.
Median PFS and OS following pembrolizumab and lenvatinib therapy is similar to traditional cytotoxic regimens.
Pembrolizumab and lenvatinib therapy was only used in patients who had failed two or more lines of therapy.
Background and Objectives: Screening for breast cancer in highly penetrant mutation carriers during pregnancy and lactation is challenging and consensus guidelines are lacking. This study evaluates the lapse in screening and the interval pregnancyassociated breast cancer rate.Methods: A single-institution retrospective cohort study of pregnant and lactating patients with known pathogenic germline mutations was performed. Lapse in screening was defined as the interval between the last screening imaging exam obtained before last menstrual period and the subsequent screening imaging.Results: Out of 685 patients, 42 had 1-3 evaluable pregnancies (54 total -28 managed in High Risk Breast Clinic and 26 by OB/GYN). Mutations were observed in patients in BRCA1 (49%), BRCA2 (36%), CDH1 (5%), CHEK2 (2%), ATM (2%), NF1 (3%), and MSH2 (3%). The average screening lapse was 25 [19, 30] months for patients followed in the High Risk Clinic versus 32.5 [21, 65.75] months for patients followed with Routine Care (p = 0.035). We identified three cases of pregnancyassociated breast cancer (interval cancer rate 6%). Conclusions: Patients with highly penetrant mutations are at risk for the development of interval pregnancy-associated breast cancer. Development of consistent screening guidelines and adherence to those guidelines is needed for this patient population.hereditary breast and ovarian cancer syndrome, cancer screening, pregnancy, pregnancyassociated breast cancer
| INTRODUCTIONPregnancy-associated breast cancer, which includes cancer diagnosed both during pregnancy and in the first year postpartum, is the second most common malignancy in pregnancy affecting approximately 1 in 3000 to 1 in 10 000 women. 1,2 A recent study of women with pregnancy-associated breast cancer found that nearly 20% of the women diagnosed were BRCA1 or BRCA2 mutation carriers. 3 Additionally, there is a known transient increase in maternal breast cancer risk in the 5 years following delivery not only in BRCA1 and BRCA2 mutation carriers but also in the general population. [4][5][6][7] Detecting breast cancer is difficult during the peripartum period, however, because the increase in breast density reduces the sensitivity of imaging. 2,8,9 In a nonpregnant population, it is recommended that BRCA1 and BRCA2 mutation carriers begin high-risk screening with annual breast MRI with contrast as well as a biannual clinical breast
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