Purpose Worldwide, spinal cord injuries are associated with diminished participation in the labor market. Inconclusive reporting and differences between workplace settings for individuals with spinal cord injury (SCI) make conceptualizing return to work rates among this population inherently challenging. The objectives of this study are to explore factors associated with return to work (RTW) following an SCI. Moreover, the factors were classified according to the work disability prevention framework. Finally, we conducted a meta-analysis of the prevalence of RTW following an SCI. Methods Original articles were identified through a literature search in four health databases. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the mapping and identification of records. Included studies contained primary studies that included the nature of the injury, antecedent factors associated with the injury, and study characteristics and RTW outcomes. Exclusion criteria for the studies included if there was no discussion of RTW outcomes, systematic reviews, and meta-analyses. Results A total of 461 full-text articles were assessed for eligibility, and eight studies were included and assessed using the Critical Appraisal Skills Programme checklist, Risk of Bias, and Newcastle–Ottawa Scale. Four studies identified personal system factors, four identified healthcare system factors, two identified compensation system factors, and one identified workplace system factors. Conclusions Attempts to optimize RTW among persons with SCI are inherently difficult due to the diversity of this client population. Findings from the studies included in this systematic review support the utility of interventions for facilitating RTW, such as vocational rehabilitation and workplace accommodations, while simultaneously acknowledging the limitations in identifying specific interventions as facilitatory or inhibitory throughout the process.
Background Estrogen receptor positive (ER+) progesterone receptor negative (PR-) tumors are a distinct subset of breast cancers that are not well characterized. It is critical to better understand the biology of ER+PR- tumors and tailor therapy accordingly for this unique subgroup. The objective of this study is to compare the ER+PR- subgroup of breast cancer as compared to the double positive ER+PR+ group in a large, well-characterized database to determine if the tumors that are PR- are associated with higher rates of genomic testing and chemotherapy receipt. Methods We identified patients diagnosed with ER+Her2-, Stage 1-3 invasive breast cancer from 2010-2015 in the National Cancer Database. We excluded patients who received neoadjuvant therapy. Demographics and clinical characteristics for the ER+PR+ and ER+PR- groups were obtained. Differences between groups were assessed using the chi-square test. Multivariable logistic regression analysis was performed on both the node negative and node positive patients in order to identify factors independently associated with having a genomic test and receiving chemotherapy in the ER+PR+ and ER+PR- cohorts. Results Of the 363,945 eligible patients, 327,357 (89.9%) patients had ER+PR+ breast cancer and 36,588 (10.1%) had ER+PR- breast cancer. A trend towards larger tumor size in the ER+PR- population as compared to the ER+PR+ population was noted with 23.1% vs 17.3% of tumors 2-5cm and 2.2% vs 1.2% of tumors > 5cm, respectively. Higher grade was also seen in the ER+PR- group as compared to the ER+PR+ group with 27.1% versus 11.7% grade 3 tumors. In both the node negative and node positive populations, genomic testing was less likely to be sent on a PR- breast cancer than a PR+ breast cancer. When genomic testing was sent, there were more high risk Oncotype Recurrence scores (RS > 30) in the PR- group than the PR+ group. For node negative breast cancer high risk Oncotype recurrence scores were found in 32.4% of the ER+PR- population versus 5.6% in the ER+PR+ population. In the node positive cohort high risk Oncotype Recurrence scores were seen in 27.8% of the ER+PR- population as compared to 5.0% in the ER+PR+ population. Patients with discordant ER+PR- breast cancer were more likely to receive chemotherapy than their ER+PR+ counterparts in both the node negative cohort (32.2% vs 12.7%) and the node positive cohort (73.2% vs 64.5%). Conclusion There have been limited studies to date specifically focused on the ER+PR- subgroup. Patients with ER+PR- breast cancer have a higher grade, larger size, higher risk genomic testing, and are more likely to receive chemotherapy than their ER+PR+ counterparts. Discordance in hormone receptor status contributes to a more aggressive type of breast cancer that may impact clinical and treatment decisions. Citation Format: Poornima Saha, Angeline Yu, Priya Thakkar, Kristine Kuchta, Katharine Yao. Trends in clinical treatment of early stage ER+PR- breast cancer in the National Cancer Database [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-02.
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