Danielle M. Boselli

Surgical Decision Making in the BRCA-Positive Population: Institutional Experience and Comparison with Recent Literature.

A retrospective study was performed to document the uptake and extent of surgical intervention in patients with a known mutation in the BRCA1/2 genes and associated outcomes. Data were collected retrospectively on BRCA‐positive patients with and without cancer at the time of genetic testing. Our findings were compared to those published in the current literature. Of patients with cancer at testing, 61% chose bilateral mastectomies. Of patients without cancer, 54% chose risk‐reducing surgery (RRS) including risk‐reducing mastectomy (RRM), risk‐reducing salpingo‐oophorectomy (RRSO), or both. Time to surgery was significantly shorter to RRSO than to RRM. The literature suggests and our data support that acceptance of RRM in the BRCA‐positive population has gradually increased over time. Consistently high rates of RRSO uptake and short intervals from time‐of‐testing to RRSO demonstrate that RRSO is still more acceptable to this population than RRM.

Outcomes of a Structured Education Intervention for Latinas Concerning Breast Cancer and Mammography.

Objective: This study examined the utility of living room and church-based small group educational sessions on breast cancer and mammography, for under-served Latinas in North Carolina, USA. Design: Non-randomised, single arm design. Setting: A total of 329 self-selected Latinas participated in 31 small group educational classes in church and home locations in rural and urban settings, and underwent pre- and post-intervention testing of knowledge about breast cancer and mammography. Method: Participants completed educational surveys at baseline before intervention (329), immediately after intervention (329) and 3 months after intervention (223 participants). Results: Misconceptions still exist about breast cancer risk, prevalence and mammography use among Latinas, with the greatest knowledge deficit being in the domain of risk factors. Increases of knowledge were achieved when compared to baseline measures as a result of the interventions described in this paper, which were retained at 3 months re-testing. Many eligible women were not receiving mammograms due to financial barriers. Conclusions: Education sessions of the kind described in this paper are useful in enhancing retained knowledge in breast cancer education for US Latinas.

Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting

PurposeThe goals of this study were to (1) describe the prevalence and correlates of patient-reported religious/spiritual (R/S) needs in outpatient oncology patients and (2) estimate the associations of R/S concerns with acceptance of an R/S intervention offered by phone.MethodsThis was a retrospective analysis of data collected from distress screenings and spiritual care interventions at an outpatient cancer center from March 1, 2017 to May 9, 2017. Patients (n = 1249) used a tablet to self-report the following R/S concerns: spiritual or religious concern, isolation, struggle to find hope/meaning in life, concern for family, fear of death, shame/guilt, and doubts about faith. Patients were also screened for anxiety, depression, and distress. A chaplain contacted patients that reported one or more R/S concerns to offer R/S interventions via telephone or in person.ResultsApproximately one third (29.9%) of surveyed patients indicated at least one R/S need. Younger age, female gender, anxiety, depression, and distress were associated with indication of specific R/S concerns. Fear of death (OR 1.64 [1.02, 2.66], p = 0.043), struggle to find meaning/hope in life (OR 2.47 [1.39, 4.39], p = 0.002), and anxiety (p = 1.003) were associated with increased odds of intervention acceptance.ConclusionEffective screening practices are needed for chaplains to prioritize patients most in need. This exploratory study suggests that screening for struggle to find meaning/hope in life, fear of death, and anxiety will help chaplains identify patients who have R/S concerns and will likely accept R/S interventions. Developing effective telehealth practices like this is an important direction for the field.

External validity of two nomograms for predicting distant brain failure after radiosurgery for brain metastases in a bi-institutional independent patient cohort

Patients treated with stereotactic radiosurgery (SRS) for brain metastases (BM) are at increased risk of distant brain failure (DBF). Two nomograms have been recently published to predict individualized risk of DBF after SRS. The goal of this study was to assess the external validity of these nomograms in an independent patient cohort. The records of consecutive patients with BM treated with SRS at Levine Cancer Institute and Emory University between 2005 and 2013 were reviewed. Three validation cohorts were generated based on the specific nomogram or recursive partitioning analysis (RPA) entry criteria: Wake Forest nomogram (n = 281), Canadian nomogram (n = 282), and Canadian RPA (n = 303) validation cohorts. Freedom from DBF at 1-year in the Wake Forest study was 30% compared with 50% in the validation cohort. The validation c-index for both the 6-month and 9-month freedom from DBF Wake Forest nomograms was 0.55, indicating poor discrimination ability, and the goodness-of-fit test for both nomograms was highly significant (p < 0.001), indicating poor calibration. The 1-year actuarial DBF in the Canadian nomogram study was 43.9% compared with 50.9% in the validation cohort. The validation c-index for the Canadian 1-year DBF nomogram was 0.56, and the goodness-of-fit test was also highly significant (p < 0.001). The validation accuracy and c-index of the Canadian RPA classification was 53% and 0.61, respectively. The Wake Forest and Canadian nomograms for predicting risk of DBF after SRS were found to have limited predictive ability in an independent bi-institutional validation cohort. These results reinforce the importance of validating predictive models in independent patient cohorts.