A rotation in mo improves the perceptions of im residents about oncology and their comfort level in dealing with cancer patients and patients at end of life. Overall cancer knowledge is also improved. Given those benefits, im residency programs should encourage most of their residents to complete a mo rotation.

Background: For patients with metastatic hormone receptor (HR)-positive, HER2-negative breast cancer who progress on a non-steroidal aromatase inhibitor (NSAI), exemestane plus everolimus (EE) has been shown to prolong progression-free survival in comparison to exemestane alone. In the current era, many patients are now receiving a CDK4/6 inhibitor with first-line NSAI therapy. There is limited data describing the utilization and effectiveness of treatments following hormonal therapy - CDK4/6 inhibitor combinations, including EE. The aim of this study was to describe the real-world clinical experience and outcomes associated with EE amongst patients with and without prior CDK4/6 inhibitor exposure treated in our provincial jurisdiction. Methods: All patients prescribed EE from January 1, 2016 through May 10, 2018 were obtained from the Alberta Health Services CancerControl Breast Data Mart (BDM). Patients with HER2+ disease, had received <1 cycle of EE or who had been on a placebo controlled trial of hormonal therapy +/- CDK4/6 inhibitor prior to EE were excluded. Review of the electronic medical record was undertaken to obtain detailed information on lines of treatment prior to EE, EE dosing and reason for EE discontinuation. The cohort was described and analyzed in total and by prior CDK4/6 inhibitor exposure. Time on treatment (TOT) was defined as start of EE to last dose or June 11, 2018 (censoring for data extraction) and was calculated using the Kaplan Meier method. The log rank test was used to compare TOT. Results: There were 110 patients extracted and 88 eligible for analysis (3 excluded for HER2+ disease, 14 for receipt of <1 cycle EE and 5 for participation on a placebo controlled trial of hormonal therapy +/- CDK4/6 inhibitor prior to EE. Median age 62.4 years (range 32.1-86.6 years). EE was administered first line in 12.5%, second line in 46.6% and third or greater line in 40.9%. Median time from start of first line therapy to start of EE was 19.3 months (range 0.3-72.1 months). Visceral metastases at start of EE in 62.5%. EE mean starting dose 7.3 mg (SD 2.5 mg) and mean last dose recorded 7.0 mg (SD 2.7 mg). At time of data extraction, 69 patients had stopped EE, 68.1% for progression and 31.9% for toxicity or other reason. Twenty patients had hormonal therapy + CDK4/6 inhibitor prior to EE. In the first line setting, 10 patients had letrozole and palbociclib. In the second line setting or greater, 5 patients had letrozole + palbociclib, 1 patient had tamoxifen + palbociclib and 4 patients had fulvestrant + palbociclib. Median time on hormonal therapy + CDK4/6 inhibitor was 12.0 months (range 4.0-20.9 months). Those with hormonal therapy + CDK4/6 inhibitor were more likely to have visceral metastases (p=0.02). Median time on treatment for the CDK4/6 exposed vs naïve groups was similar (5.8 vs 5.3 months, p=0.952). Median overall survival not yet reached. Conclusion: In a cohort of patients who have progressed on hormonal therapy + CDK4/6 inhibitor within 2 years, subsequent EE is a clinically meaningful treatment option in the setting of HR-positive/HER2-negative metastatic breast cancer. TOT was similar for CDK4/6 inhibitor exposed and naïve patients. Citation Format: Lupichuk SM, Recaldin B, Nixon NA, Mututino A, Joy AA. Real-world experience using exemestane and everolimus in patients with hormone receptor positive/HER2 negative breast cancer with and without prior CDK4/6 inhibitor exposure [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-06.

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Background: I-SPY 2 is an innovative collaboration to assess 8-12 investigational agents and numerous biomarkers in an adaptive, neoadjuvant clinical trial for patients with locally advanced breast cancer and a high likelihood of recurrence. The first site opened in March 2010, and the trial will eventually open in up to 20 sites and enroll 800 patients. It is well known that patients who have recently been diagnosed with breast cancer are often overwhelmed, frightened and cognitively impaired. Making treatment decisions and dealing with the strain of treatment are among the most traumatic events patients are likely to experience. Nevertheless, they are often significantly helped by peer support. Methods: The Breast Cancer Network of Strength (formerly Y-ME) provides 24x7 peer support for callers seeking information and/or support related to breast cancer. All peer counselors are trained and certified breast cancer survivors. I-SPY 2 partnered with this organization to leverage their services in the I-SPY 2 trial. In particular, ten experienced peer counselors received a day of training to prepare them to counsel I-SPY 2 patients. They learned about the details of the trial, support materials available to patients (i.e., I-SPY 2 brochure, DVD and website), and specific challenges patients going through the trial are likely to face. Training included extensive role play exercises. When patients agree to treatment within the I-SPY 2 trial, they are offered the option of peer counseling. If they so choose, a counselor will call five times during their six months of treatment. Calls will be scheduled to meet the needs of individual patients, but are expected to take place: 1) shortly after enrollment; 2) a week after the first chemotherapy treatment; 3) shortly after completion of pacitaxel and any investigational agent; 4) shortly before surgery; and 5) shortly after surgery. The goals of providing peer support to I-SPY2 participants are to: 1) provide participants with an opportunity to discuss their diagnosis,treatment, and trial issues to validate emotions and provide support for dealing with the rigors of receiving breast cancer treatment; 2) help patients understand and anticipate upcoming aspects of their treatment; and 3) encourage patients to comply with trial requirements and raise concerns with their health care providers. Discussion: The I-SPY 2 trial initially planned to offer patients who were deciding whether to participate in the trial the option of speaking to a peer counselor. However, one IRB objected to this use of peer counselors despite demonstration of peer counselors being helpful and not coercive. For example, when this service was provided in CALGB 49907, a majority of patients who used the service expressed appreciation of counseling, but only about 50% who spoke to counselors enrolled in the trial. In the current study, use of peer counselors will initially be restricted to enrolled patients. However, it is likely that it be expanded to patients contemplating participation at sites where IRBs agree. Future research will clarify which patients request counselors and why, how they view their experience, and to what extent peer counseling influences patient enrollment, compliance and trial completion. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-12-03.

Background: Research is fundamental to the management of cancer, however many studies are primarily researcher or industry led, with minimal input and involvement from the people most affected by the outcomes- the patients and caregivers. The James Lind Alliance (JLA) is a not for profit initiative that brings patients, caregivers and clinicians together in priority setting partnerships (PSPs) to determine key priorities in research. Breast cancer remains the most common cancer among women, with an estimated third of women diagnosed developing metastatic disease. With advances in treatment, women are living longer with metastatic breast cancer (MBC), in some cases many years. Objectives: The aims of this study are to utilize the JLA approach to (1) identify the unanswered questions about treatment of MBC from patient and clinical perspectives, and (2) to prioritize those that patients and clinicians agree are the most important. Methods: Following the established JLA approach, MBC patients, caregivers, and health professionals were surveyed to elicit their questions pertaining to MBC. Research questions were generated from the survey responses, and following literature review that the questions were currently not completely answered, an interim prioritization survey was conducted to identify a shortlist of questions to take to a final consensus meeting. Results: One thousand, one-hundred and ninety-four responses were collected from 668 individuals(49% patients; 13% physicians; 9% caregivers; 4% allied health care professionals; 2% patient organization representatives; 23% other), which were refined into 62 unique unanswered research questions. The interim prioritization survey was completed by 174 individuals, and the top 27 questions were taken to a final meeting where MBC patients, caregivers, and health care professionals prioritized all the questions, and reached consensus on the top 10. Conclusion: The top 10 questions cover a wide range of research questions, identified by valuable stakeholders as being priorities. These priorities can be used to fund and inform future MBC research. List of final top 10 ranked prioritiesRankQuestion1What biomarkers or intrinsic features of the tumour can be used to identify response to specific treatments and dosing schedules?2What is the role of immunotherapy for MBC?3How can treatment resistance be delayed and minimized?4What causes (i.e. cellular, genomic) breast cancer cells to metastasize, and what changes allow them to penetrate the blood brain barrier?5What is the right sequence of therapy in MBC?6Does local therapy (radiation or surgery to sites of metastatic disease) improve survival outcomes in MBC?7Is continuous treatment with systemic therapy (including HER2-targeted therapy and chemotherapy) better than intermittent?8Does early palliative care improve outcomes for MBC patients?9What are the best methods of education for patients around treatment options and decision making that can lead to improved patient outcomes?10Can safer, more accurate methods, including blood tests of detecting spread of disease (including following curative treatment) be developed? Citation Format: Nixon NA, Simmons C, Lemieux J, Verma S. What research questions matters most to patients? Final results of the metastatic breast cancer priority setting partnership [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-09.