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Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC) and appears to have a distinct biology. Inconsistent findings regarding disease-free survival (DFS) are probably due to the fact that histologic type is related to hormone receptor status. This study aims to determine whether the type of the primary breast cancer histology is an independent prognostic factor for DFS, the risk pattern of loco-regional recurrences and distant metastases (DM), and whether it is a prognostic factor for the site of DM. All Dutch women diagnosed between 2003 and 2005 with ILC (n = 2,949) or IDC (n = 22,378) were selected from the Netherlands Cancer Registry. DFS was assessed using proportional hazard regression analysis. Compared to patients with IDC, those with ILC were significantly older and more likely to have more than three positive lymph nodes and have larger, better differentiated, more multifocal, and hormone receptor positive tumors (all P < 0.001). ILC was more likely to metastasize to the gastrointestinal organs and bones and less likely to the lung, central nervous system, and lymph nodes. Within the ER+PR+ and ER+PR- subgroups ILC was still more likely to metastasize to gastrointestinal organs and less likely to the lung. The timing of recurrence was correlated to hormone receptor status, independent of histological type. Highest risks were observed among ER-PR- patients within 2 years of surgery. Multivariable analysis showed that histological type is not an independent significant prognostic factor of DFS for the first 3 years post-surgery and thereafter (<3 years HR 0.91, 95 % CI 0.78-1.06, >3 years HR 1.07, 95 % CI 0.88-1.30). Histological type should not be considered an important prognostic factor for the risk and risk pattern of recurrences.

Main ObjectiveSince palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.MethodsWe performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Main Results and Their SignificanceOf the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51–2.12) or COPD (OR 1.39; 95% CI: 1.15–1.69) than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22–1.40), agitation/delirium (OR 1.57; 95% CI: 1.47–1.68), exhaustion (OR 2.89; 95% CI: 2.61–3.20), euthanasia-related questions (OR 2.65; 95% CI: 2.37–2.96) or existential issues (OR 1.55; 95% CI: 1.31–1.83).ConclusionIn conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

Introduction: Many studies investigated disease free survival after breast cancer treatment. A few studies focused on patterns of recurrence risk over time. However, they ignored the impact of histology. This study aimed to determine differences in recurrence dynamics on population-based data between patients with a ductal breast cancer (DBC) and lobular breast cancer (LBC). Methods: All surgically treated women diagnosed in 2003–2004 with invasive DBC or LBC, with no distant metastases or second primary breast cancer were selected from the Netherlands Cancer Registry. The recurrence patterns were studied using the life-table method to estimate the hazard rate for the first recurrence with the worst prognosis (locoregional (LRR) or distant metastases), that is, the conditional probability of manifesting recurrence in a time interval, given that the patient is clinically free of any recurrence at the beginning of the interval. The wilcoxon test was used to determine differences in recurrence patterns between DBC and LBC. Results: Of 16,231 women identified, 87% had DBC and 13% LBC. LRR was found in 4% of the DBC and in 3% of the LBC patients, whereas metastases were found in 11% and 10% of patients, respectively. Notably, in DBC patients a peak in recurrence rate was seen between 1–2 years after diagnosis, both for LRR and distant metastases. On the other hand, in LBC patients the recurrence pattern did not show major peaks: after 2 years the curve revealed an almost steady level for LRR and distant metastases. This recurrence pattern was significantly different (P=&lt;0.001). Moreover, the influence of age, stage and treatment on recurrence differed between DBC and LBC. We also noticed a difference in localization of metastasis. Conclusion: Our study showed an overall equal number of recurrences after DBC and LBC, but with a totally different recurrence pattern, which could have implications on follow-up of the patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-11.

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