Erika Brown

Beta-Blocker Use Is Associated With Improved Relapse-Free Survival in Patients With Triple-Negative Breast Cancer

PURPOSE To examine the association between beta-blocker (BB) intake, pathologic complete response (pCR) rates, and survival outcomes in patients with breast cancer treated with neoadjuvant chemotherapy. PATIENTS AND METHODS We retrospectively reviewed 1,413 patients with breast cancer who received neoadjuvant chemotherapy between 1995 and 2007. Patients taking BBs at the start of neoadjuvant therapy were compared with patients with no BB intake. Rates of pCR between the groups were compared using a χ² test. Cox proportional hazards models were fitted to determine the association between BB intake, relapse-free survival (RFS), and overall survival (OS). RESULTS Patients who used BBs (n = 102) were compared with patients (n = 1,311) who did not. Patients receiving BBs tended to be older and obese (P < .001). The proportion of pCR was not significantly different between the groups (P = .48). After adjustment for age, race, stage, grade, receptor status, lymphovascular invasion, body mass index, diabetes, hypertension, and angiotensin-converting enzyme inhibitor use, BB intake was associated with a significantly better RFS (hazard ratio [HR], 0.52; 95% CI, 0.31 to 0.88) but not OS (P = .09). Among patients with triple-negative breast cancer (TNBC; n = 377), BB intake was associated with improved RFS (HR, 0.30; 95% CI, 0.10 to 0.87;P = .027) but not OS (HR, 0.35; 95% CI, 0.12 to 1.00;P = .05). CONCLUSION In this study, BB intake was associated with improved RFS in all patients with breast cancer and in patients with TNBC. Additional studies evaluating the potential benefits of beta-adrenergic blockade on breast cancer recurrence with a focus on TNBC are warranted.

Use of ACE Inhibitors and Angiotensin Receptor Blockers and Primary Breast Cancer Outcomes.

BACKGROUND: ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may have anti-tumor properties. We investigated whether the use of ACEI/ARBs affects the clinical outcomes of primary breast cancer patients receiving taxane and anthracycline-based neoadjuvant chemotherapy. METHODS: We included 1449 patients with diagnosis of invasive primary breast cancer diagnosed at the MD Anderson Cancer Center between 1995 and 2007 who underwent neoadjuvant chemotherapy. Of them, 160 (11%) patients were identified by review of their medical record, as ACEI/ARBs users. We compared pathologic complete response (pCR) rates, relapse-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) between ACEI/ARB users and non-users. Descriptive statistics and Cox proportional hazards model were used in the analyses. RESULTS: There was no difference in the pCR rates between ACEI/ARB users and non-users (16% vs 18.1%, p-=0.50). After adjustment for important demographic and clinical characteristics, no significant differences between ACEI/ARB users and nonusers were observed in RFS (HR=0.81; 95% CI=0.54-1.21), DSS (HR=0.83; 95% CI=0.52-1.31), or OS (HR=0.91; 95% CI =0.61-1.37). In a subgroup analysis, the 5-year RFS was 82% in ARB only users versus 71% in ACEI/ARB non-users (P=0.03). In the multivariable analysis, ARB use was also associated with a decreased risk of recurrence (HR=0.35; 95% CI=0.14-0.86). No statistically significant differences in DSS or OS were seen. CONCLUSION: No differences in pCR and survival outcomes were seen between ACEI/ARB users and non-users among breast cancer patients receiving neoadjuvant chemotherapy. ARB use may be associated with improved RFS. Further research is needed to validate this finding.

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy

PURPOSE Incident investigation, reporting, and learning are core elements of quality improvement in radiation treatment. This report describes the development of a Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT), focusing especially on the taxonomy. METHODS AND MATERIALS The NSIR-RT was developed to provide a framework in Canada for reporting and analyzing radiation treatment incidents. A key objective was to assure compatibility with other international reporting systems to facilitate future information exchange. The Canadian community was engaged at every step of the development process through Delphi consensus building and inter-user agreement testing to promote awareness of the system and motivate broad-based utilization across the country. RESULTS The final taxonomy was comprised of 6 data groups (impact, discovery, patient, details, treatment delivery, and investigation) and 33 data categories with predefined menu options. There was a high level agreement within the Canadian community about the final suite of data categories, and broad alignment of these categories with the World Health Organization and other American and European radiation treatment incident classifications. CONCLUSIONS The Canadian NSIR-RT taxonomy will be implemented as an online, web-based reporting and analysis system. It is expected that the taxonomy will evolve and mature over time to meet the changing needs of the Canadian radiation treatment community and support radiation treatment incident learning on a global scale.

Bisphosphonates and pathologic complete response to taxane and anthracycline-based neoadjuvant chemotherapy in patients with breast cancer

Several studies have suggested that bisphosphonates have an antitumor effect. In the current study, the authors sought to evaluate whether the use of bisphosphonates increased the rate of pathological complete response (pCR) in patients with breast cancer.

Improving patient outcomes and radiotherapy systems: A pan‐Canadian approach to patient‐reported outcome use

Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

Quality in cancer care: Lessons from the Canadian partnership for quality radiotherapy

With the increasing complexity of cancer treatment and the emergence of technologies that offer individualized therapy options for people being treated for the disease, cancer care professionals are facing greater demands for knowledge exchange and information input. The Canadian Partnership for Quality Radiotherapy was established in 2010 in response to such demands and has used both bottom-up and top-down approaches to successfully support improved program planning, treatment delivery, and patient care within the Canadian radiation treatment community. Focusing on shared priorities using this bilateral engagement is a lesson that can be applied broadly across the cancer system.

Patient engagement in radiation therapy The development of guidelines for current Canadian practices

Radiation therapy service quality is not only defined by the technical aspects of care—the patient’s involvement and satisfaction also contribute largely to determining the quality of care received. Although there have been recent increases in support for the development of patient engagement activities throughout Canada, the lack of guidance and knowledge of patient engagement techniques within the radiotherapy context limits implementation. Without processes to obtain first-hand insight from patients, the need for these programs is overlooked. With a commitment to improving quality and consistency of care, the Canadian Partnership for Quality Radiotherapy recognized the need for a set of national guidelines on patient engagement in radiation therapy service delivery. Making use of the perspectives and first-hand experience of patient representatives, this initiative aims to develop a pan-Canadian guidance document that radiation therapy centres can adopt for successful integration of patient engagement through core activities of service delivery.

176: Measuring Uptake of the Canadian Partnership for Quality Radiotherapy (CPQR) Programmatic Key Quality Indicators (KQI): A Pan-Canadian Audit of Compliance

withdrawn 181 PATIENT EXPERIENCE SURVEY OF EARLY-STAGE BREAST CANCER PATIENTS UNDERGOING WHOLE BREAST RADIOTHERAPY Grace Lee, Robert Dinniwell, Anthony Fyles, Tatiana Conrad, Kathy Han, Wilfred Levin, Fei-Fei Liu, Susanne Lofgren, Alexandra Koch-Fitsialos, Gerald Devins, Nora Emad, Bethany Pitcher, Tony Panzarella, Anne Koch Princess Margaret Cancer Centre, Toronto, ON University of Toronto, Toronto, ON Purpose: Adjuvant breast radiotherapy (RT) is a standard treatment option in women with early-stage breast cancer following lumpectomy. Timeliness of RT treatment can impact patient satisfaction. The objectives of this study are to assess: 1) patient satisfaction of their whole breast RT; 2) patient preference for timing of RT start after CT simulation (CTSim); and 3) factors that influence patient stress and quality of life. Methods and Materials: Women undergoing whole breast RT were given a survey before RT treatment and at treatment completion. Patients were offered treatment either through the conventional process (ConvProcess), where RT starts typically within 1-2 weeks of CTSim, or the QuickStart (QS) process, where RT starts one day after CTSim. The pre-treatment (PRE-Tx) survey included questions to understand the social impact of RT, and the post-treatment (POST-Tx) survey included questions relating to social climate and patient satisfaction. Questions relating to RT start preference, stress (Perceived Stress Scale [PSS]) and quality of life (Illness Intrusiveness Ratings Scale [IIRS]), were assessed both at PRE-Tx and POST-Tx. An analysis of covariance was used to determine if the RT process impacted PSS and IIRS, and t-tests were used as a secondary analysis. Fisher’s Exact test was used where appropriate. Results: Ninety-six patients completed the PRE-Tx survey and 88 completed both surveys (QS process n = 28; ConvProcess n = 60). All patients indicated they had a positive experience with the RT

A national strategy for quality and safety in radiotherapy: A comprehensive quality improvement approach.

148 Background: Canada utilizes a public payer, private health care delivery model, delegated sub-nationally. Effective coordination of uniform access to safe, high quality care can be challenging in this and similar international models. Quality improvement in radiotherapy (RT) involves approximately 50% of all cancer patients who will require RT during their illness. The Canadian Partnership for Quality Radiotherapy (CPQR) is a national quality improvement approach employing pan-Canadian engagement of a multi-disciplinary group of physicians, allied health professionals, administrators and patients. The objectives are to create a national culture of safe, high quality RT delivery for all patients; develop and implement a comprehensive sustainable national program for safe, high quality RT. METHODS All CPQR QA products/programs are processed using standard methodology of review and validation through community consultation, and endorsed by national stakeholders. QA products are incorporated into national QA guidelines and indicators for RT programs, technical equipment and patient experiences; integrating these into a national accreditation program; developing a national RT incident reporting and learning system. Active dissemination strategies use bottom-up and top-down approaches. RESULTS The national RT programmatic QA guidelines and key quality indicators were released in 2011 and 2013, with 3849 downloads. Approximately 50% of Canadian RT centres indicated implementing CPQR guidelines and changing local QA practices. 9 equipment QA guidelines were developed and validated, 6 are in development. National monitoring and learning structures are being developed through an accreditation program and incident reporting repository to be operated by national organizations for sustainability. Knowledge exchange activities included 26 presentations and 10 national/international invited discussions. A national systematic evaluation process will be executed shortly. CONCLUSIONS CPQRs national RT QA development and implementation approach is a successful model that can be adopted in other areas of healthcare considering system improvement.