The Journal of Community and Supportive Oncology

SAN ANTONIO – In a roundtable at the 2014 San Antonio Breast Cancer Symposium, Dr. Jame Abraham, Dr. Linda Bosserman, and Dr. Debra Patt discussed their top selections from the meeting’s presentations.

Among the topics were the promising findings in a small study involving the novel immune checkpoint inhibitor pembrolizumab in advanced triple-negative breast cancer; the SOFT trial, which looked at ovarian suppression with either tamoxifen or an aromatase inhibitor in premenopausal women with hormone receptor–positive disease; and the negative findings on the use of erythropoietin in patients with metastatic breast cancer.

The editors also highlighted findings showing no difference in disease-free survival between node-negative patients receiving six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide and those receiving four cycles of Adriamycin and cyclophosphamide; and data from the Women’s Intervention Nutrition Study, which showed that lifestyle and dietary changes can have a notable impact on outcomes in women with early-stage, treated breast cancer.

Management of therapy side effects, fertility concerns in younger patients, patient quality of life, and the cost effectiveness of treatment were a subtext to the editors’ discussions of the clinical findings, as they highlighted the importance of looking closely at the risk-benefit relationship in delivering quality, affordable, personalized care to patients with breast cancer.

Dr. Abraham is director of the breast medical oncology at the Cleveland Clinic. Dr. Bosserman is clinical assistant professor at City of Hope Cancer Center, Duarte, Calif. Dr. Patt is a partner at Texas Oncology, Austin, and director of health care informatics at McKesson Specialty Health.

[email protected]

SAN ANTONIO – In a roundtable at the 2014 San Antonio Breast Cancer Symposium, Dr. Jame Abraham, Dr. Linda Bosserman, and Dr. Debra Patt discussed their top selections from the meeting’s presentations.

Among the topics were the promising findings in a small study involving the novel immune checkpoint inhibitor pembrolizumab in advanced triple-negative breast cancer; the SOFT trial, which looked at ovarian suppression with either tamoxifen or an aromatase inhibitor in premenopausal women with hormone receptor–positive disease; and the negative findings on the use of erythropoietin in patients with metastatic breast cancer.

The editors also highlighted findings showing no difference in disease-free survival between node-negative patients receiving six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide and those receiving four cycles of Adriamycin and cyclophosphamide; and data from the Women’s Intervention Nutrition Study, which showed that lifestyle and dietary changes can have a notable impact on outcomes in women with early-stage, treated breast cancer.

Management of therapy side effects, fertility concerns in younger patients, patient quality of life, and the cost effectiveness of treatment were a subtext to the editors’ discussions of the clinical findings, as they highlighted the importance of looking closely at the risk-benefit relationship in delivering quality, affordable, personalized care to patients with breast cancer.

Dr. Abraham is director of the breast medical oncology at the Cleveland Clinic. Dr. Bosserman is clinical assistant professor at City of Hope Cancer Center, Duarte, Calif. Dr. Patt is a partner at Texas Oncology, Austin, and director of health care informatics at McKesson Specialty Health.

[email protected]

SAN ANTONIO – In a roundtable at the 2014 San Antonio Breast Cancer Symposium, Dr. Jame Abraham, Dr. Linda Bosserman, and Dr. Debra Patt discussed their top selections from the meeting’s presentations.

Among the topics were the promising findings in a small study involving the novel immune checkpoint inhibitor pembrolizumab in advanced triple-negative breast cancer; the SOFT trial, which looked at ovarian suppression with either tamoxifen or an aromatase inhibitor in premenopausal women with hormone receptor–positive disease; and the negative findings on the use of erythropoietin in patients with metastatic breast cancer.

The editors also highlighted findings showing no difference in disease-free survival between node-negative patients receiving six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide and those receiving four cycles of Adriamycin and cyclophosphamide; and data from the Women’s Intervention Nutrition Study, which showed that lifestyle and dietary changes can have a notable impact on outcomes in women with early-stage, treated breast cancer.

Management of therapy side effects, fertility concerns in younger patients, patient quality of life, and the cost effectiveness of treatment were a subtext to the editors’ discussions of the clinical findings, as they highlighted the importance of looking closely at the risk-benefit relationship in delivering quality, affordable, personalized care to patients with breast cancer.

Dr. Abraham is director of the breast medical oncology at the Cleveland Clinic. Dr. Bosserman is clinical assistant professor at City of Hope Cancer Center, Duarte, Calif. Dr. Patt is a partner at Texas Oncology, Austin, and director of health care informatics at McKesson Specialty Health.

[email protected]

Background Evaluations of the costs of palliative external beam radiation therapy (EBRT) for treatment of bone metastases are limited.

Objective To summarize EBRT lifetime care patterns in deceased men with metastatic prostate cancer treated in a cancer hospital in the United States.

Methods A retrospective review of electronic health records identified deceased adult prostate cancer (ICD-9 185.xx) patients with bone metastases (ICD-9 198.5) and who were treated for bone pain and metastasis management with EBRT between January 1, 1995 and December 17, 2012. Common Procedural Terminology codes were used to identify all EBRT episodes (total billed EBRT services; initial and final evaluation) to calculate length of EBRT treatments and per episode costs (2011 US$). Bootstrapping approximated the 95% confidence interval for final cost estimates.

Results 176 men were identified; 19 (10.8%) had bone metastases in >1 site. Eighty-nine men (50.6%) received >1 EBRT episode (range, 1-6; median, 2), with first episode length ranging from 1-44 calendar days (mean, 13.4; SD, 8.4) at a mean cost of $7,084 (SD, $4,028). About 70% of costs were attributable to hospital charges and 30% to physician charges.

Limitations Small sample size limits broad applicability to large populations of men with prostate cancer.

Conclusion Care costs for EBRT constitute one of many costs that should be taken into account when planning for palliative care of prostate cancer and bone metastasis.

Funding Grant from Amgen and support was provided by the Huntsman Cancer Institute for all datasets within the Utah Population Database.

Click on the PDF icon at the top of this introduction to read the full article.

Background Evaluations of the costs of palliative external beam radiation therapy (EBRT) for treatment of bone metastases are limited.

Objective To summarize EBRT lifetime care patterns in deceased men with metastatic prostate cancer treated in a cancer hospital in the United States.

Methods A retrospective review of electronic health records identified deceased adult prostate cancer (ICD-9 185.xx) patients with bone metastases (ICD-9 198.5) and who were treated for bone pain and metastasis management with EBRT between January 1, 1995 and December 17, 2012. Common Procedural Terminology codes were used to identify all EBRT episodes (total billed EBRT services; initial and final evaluation) to calculate length of EBRT treatments and per episode costs (2011 US$). Bootstrapping approximated the 95% confidence interval for final cost estimates.

Results 176 men were identified; 19 (10.8%) had bone metastases in >1 site. Eighty-nine men (50.6%) received >1 EBRT episode (range, 1-6; median, 2), with first episode length ranging from 1-44 calendar days (mean, 13.4; SD, 8.4) at a mean cost of $7,084 (SD, $4,028). About 70% of costs were attributable to hospital charges and 30% to physician charges.

Limitations Small sample size limits broad applicability to large populations of men with prostate cancer.

Conclusion Care costs for EBRT constitute one of many costs that should be taken into account when planning for palliative care of prostate cancer and bone metastasis.

Funding Grant from Amgen and support was provided by the Huntsman Cancer Institute for all datasets within the Utah Population Database.

Click on the PDF icon at the top of this introduction to read the full article.

Background Evaluations of the costs of palliative external beam radiation therapy (EBRT) for treatment of bone metastases are limited.

Objective To summarize EBRT lifetime care patterns in deceased men with metastatic prostate cancer treated in a cancer hospital in the United States.

Methods A retrospective review of electronic health records identified deceased adult prostate cancer (ICD-9 185.xx) patients with bone metastases (ICD-9 198.5) and who were treated for bone pain and metastasis management with EBRT between January 1, 1995 and December 17, 2012. Common Procedural Terminology codes were used to identify all EBRT episodes (total billed EBRT services; initial and final evaluation) to calculate length of EBRT treatments and per episode costs (2011 US$). Bootstrapping approximated the 95% confidence interval for final cost estimates.

Results 176 men were identified; 19 (10.8%) had bone metastases in >1 site. Eighty-nine men (50.6%) received >1 EBRT episode (range, 1-6; median, 2), with first episode length ranging from 1-44 calendar days (mean, 13.4; SD, 8.4) at a mean cost of $7,084 (SD, $4,028). About 70% of costs were attributable to hospital charges and 30% to physician charges.

Limitations Small sample size limits broad applicability to large populations of men with prostate cancer.

Conclusion Care costs for EBRT constitute one of many costs that should be taken into account when planning for palliative care of prostate cancer and bone metastasis.

Funding Grant from Amgen and support was provided by the Huntsman Cancer Institute for all datasets within the Utah Population Database.

Click on the PDF icon at the top of this introduction to read the full article.

Background Problems with sexual functioning are common following therapy for breast and gynecologic cancers, although there are few effective treatments.

Objective To assess the impact of ArginMax, a nutritional supplement comprised of extracts of L-arginine, ginseng, gingko, and damiana, as well as multivitamins and minerals, on sexual functioning and quality of life in female cancer survivors.

Methods This was a 12-week, randomized, placebo-controlled trial of eligible patients who were 6 months or more from active treatment and reporting problems with sexual interest, satisfaction, and functioning after therapy. The participants took 3 capsules of ArginMax or placebo twice daily. Outcome measures were the Female Sexual Function Inventory (FSFI) and the Functional Assessment of Cancer Therapy - General (FACT-G). Assessments were done at baseline, 4, 8, and 12 weeks.

Results 186 patients with a median age of 50 years were accrued between May 10, 2007 and March 24, 2010. 76% of the patients were non-Hispanic white. Most had breast or a gynecologic cancer (78% and 12%, respectively). At 12 weeks, there were no differences between the ArginMax group (n = 96) and placebo (n = 92) group in sexual desire, arousal, lubrication, orgasm, satisfaction or pain. However, FACT-G total scores were significantly better for participants who took ArginMax compared with those who took placebo (least squares [LS] means, 87.5 vs 82.9, respectively; P = .009). The Fact-G subscales that were most affected were Physical (25.37 vs. 23.51, P = .001) and Functional Well-Being (22.46 vs. 20.72, P = .007). Toxicities were similar for both groups.

Limitations Study results are limited by a lack of data on the participants’ psychological and physical symptoms and sexual partner variables.

Conclusions ArginMax had no significant impact on sexual functioning, but patient quality of life was significantly better at 12 weeks in participants who received ArginMax.

Funding Sponsored by NCI 3 U10 CA081851-12 and The Daily Wellness Company

Click on the PDF icon at the top of this introduction to read the full article.​

Background Problems with sexual functioning are common following therapy for breast and gynecologic cancers, although there are few effective treatments.

Objective To assess the impact of ArginMax, a nutritional supplement comprised of extracts of L-arginine, ginseng, gingko, and damiana, as well as multivitamins and minerals, on sexual functioning and quality of life in female cancer survivors.

Methods This was a 12-week, randomized, placebo-controlled trial of eligible patients who were 6 months or more from active treatment and reporting problems with sexual interest, satisfaction, and functioning after therapy. The participants took 3 capsules of ArginMax or placebo twice daily. Outcome measures were the Female Sexual Function Inventory (FSFI) and the Functional Assessment of Cancer Therapy - General (FACT-G). Assessments were done at baseline, 4, 8, and 12 weeks.

Results 186 patients with a median age of 50 years were accrued between May 10, 2007 and March 24, 2010. 76% of the patients were non-Hispanic white. Most had breast or a gynecologic cancer (78% and 12%, respectively). At 12 weeks, there were no differences between the ArginMax group (n = 96) and placebo (n = 92) group in sexual desire, arousal, lubrication, orgasm, satisfaction or pain. However, FACT-G total scores were significantly better for participants who took ArginMax compared with those who took placebo (least squares [LS] means, 87.5 vs 82.9, respectively; P = .009). The Fact-G subscales that were most affected were Physical (25.37 vs. 23.51, P = .001) and Functional Well-Being (22.46 vs. 20.72, P = .007). Toxicities were similar for both groups.

Limitations Study results are limited by a lack of data on the participants’ psychological and physical symptoms and sexual partner variables.

Conclusions ArginMax had no significant impact on sexual functioning, but patient quality of life was significantly better at 12 weeks in participants who received ArginMax.

Funding Sponsored by NCI 3 U10 CA081851-12 and The Daily Wellness Company

Click on the PDF icon at the top of this introduction to read the full article.​

Background Problems with sexual functioning are common following therapy for breast and gynecologic cancers, although there are few effective treatments.

Objective To assess the impact of ArginMax, a nutritional supplement comprised of extracts of L-arginine, ginseng, gingko, and damiana, as well as multivitamins and minerals, on sexual functioning and quality of life in female cancer survivors.

Methods This was a 12-week, randomized, placebo-controlled trial of eligible patients who were 6 months or more from active treatment and reporting problems with sexual interest, satisfaction, and functioning after therapy. The participants took 3 capsules of ArginMax or placebo twice daily. Outcome measures were the Female Sexual Function Inventory (FSFI) and the Functional Assessment of Cancer Therapy - General (FACT-G). Assessments were done at baseline, 4, 8, and 12 weeks.

Results 186 patients with a median age of 50 years were accrued between May 10, 2007 and March 24, 2010. 76% of the patients were non-Hispanic white. Most had breast or a gynecologic cancer (78% and 12%, respectively). At 12 weeks, there were no differences between the ArginMax group (n = 96) and placebo (n = 92) group in sexual desire, arousal, lubrication, orgasm, satisfaction or pain. However, FACT-G total scores were significantly better for participants who took ArginMax compared with those who took placebo (least squares [LS] means, 87.5 vs 82.9, respectively; P = .009). The Fact-G subscales that were most affected were Physical (25.37 vs. 23.51, P = .001) and Functional Well-Being (22.46 vs. 20.72, P = .007). Toxicities were similar for both groups.

Limitations Study results are limited by a lack of data on the participants’ psychological and physical symptoms and sexual partner variables.

Conclusions ArginMax had no significant impact on sexual functioning, but patient quality of life was significantly better at 12 weeks in participants who received ArginMax.

Funding Sponsored by NCI 3 U10 CA081851-12 and The Daily Wellness Company

Click on the PDF icon at the top of this introduction to read the full article.​