Can patient-reported outcome measures be used to predict consultation needs in patients with psoriasis?: A survey study

Abstract Background Patient-reported outcome measures (PROMs) are emerging tools used to capture a patient’s daily health status and enhance communication between patients and healthcare professionals. This study examined whether PROMs can be used to predict consultation needs in an outpatient clinic setting including patients diagnosed with psoriasis. Method We evaluated a nationally developed set of PROMs for psoriasis patients, which included a standard set of questionnaires that capture patients’ perceptions of their experience and quality of life. Patients (n = 187) answered the psoriasis PROMs prior to an in-person consultation. Their responses were evaluated alongside patient, doctor, and nurse opinions on whether the subsequent consultation was necessary. Additionally, comments about the consultations from the patient, doctor, and nurse were collected and provided insights as to why certain consultations were deemed necessary. Results Comparing the patient, doctor, and nurse responses addressing a need for consultation compared to the coded psoriasis PROMs results (red or green/yellow outcome), 23% of the patients with a green/yellow outcome were in need of a doctor’s consultation. Upon considering a subset of psoriasis PROMs questionnaires that reflect subjective responses (e.g., DLQI, PEST, MDI-2, and side effects), the proportion of patients that yielded a green/yellow outcome and were identified to require a doctor consultation increased to approximately 45%. Conclusions The preliminary results show that the psoriasis PROMs were supportive in the consultation but alone cannot sufficiently guide healthcare professionals to determine whether in-person consultations are required

Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the breast cancer association consortium studies

Background Previous studies have suggested that breast cancer risk factors are associated with estrogen receptor (ER) and progesterone receptor (PR) expression status of the tumors. Methods We pooled tumor marker and epidemiological risk factor data from 35 568 invasive breast cancer case patients from 34 studies participating in the Breast Cancer Association Consortium. Logistic regression models were used in case-case analyses to estimate associations between epidemiological risk factors and tumor subtypes, and case-control analyses to estimate associations between epidemiological risk factors and the risk of developing specific tumor subtypes in 12 population-based studies. All statistical tests were two-sided. Results In case-case analyses, of the epidemiological risk factors examined, early age at menarche (<= 12 years) was less frequent in case patients with PR- than PR+ tumors (P = .001). Nulliparity (P = 3 x 10(-6)) and increasing age at first birth (P = 2 x 10(-9)) were less frequent in ER- than in ER+ tumors. Obesity (body mass index [BMI] >= 30 kg/m(2)) in younger women (<= 50 years) was more frequent in ER /PR than in ER+/PR+ tumors (P = 1 x 10(-7)), whereas obesity in older women (>50 years) was less frequent in PR- than in PR+ tumors (P = 6 x 10(-4)). The triple-negative (ER-/PR-/HER2-) or core basal phenotype (CBP; triple-negative and cytokeratins [CK]5/6(+) and/ or epidermal growth factor receptor [EGFR] 1) accounted for much of the heterogeneity in parity-related variables and BMI in younger women. Case-control analyses showed that nulliparity, increasing age at first birth, and obesity in younger women showed the expected associations with the risk of ER+ or PR+ tumors but not triple-negative (nulliparity vs parity, odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.75 to 1.19, P = .61; 5-year increase in age at first full-term birth, OR = 0.95, 95% CI = 0.86 to 1.05, P = .34; obesity in younger women, OR = 1.36, 95% CI = 0.95 to 1.94, P = .09) or CBP tumors. Conclusions This study shows that reproductive factors and BMI are most clearly associated with hormone receptor-positive tumors and suggest that triple-negative or CBP tumors may have distinct etiology

Low penetrance breast cancer susceptibility loci are associated with specific breast tumor subtypes: Findings from the Breast Cancer Association Consortium

Contains fulltext : 96071.pdf (publisher's version ) (Closed access)Breast cancers demonstrate substantial biological, clinical and etiological heterogeneity. We investigated breast cancer risk associations of eight susceptibility loci identified in GWAS and two putative susceptibility loci in candidate genes in relation to specific breast tumor subtypes. Subtypes were defined by five markers (ER, PR, HER2, CK5/6, EGFR) and other pathological and clinical features. Analyses included up to 30 040 invasive breast cancer cases and 53 692 controls from 31 studies within the Breast Cancer Association Consortium. We confirmed previous reports of stronger associations with ER+ than ER- tumors for six of the eight loci identified in GWAS: rs2981582 (10q26) (P-heterogeneity = 6.1 x 10(-18)), rs3803662 (16q12) (P = 3.7 x 10(-5)), rs13281615 (8q24) (P = 0.002), rs13387042 (2q35) (P = 0.006), rs4973768 (3p24) (P = 0.003) and rs6504950 (17q23) (P = 0.002). The two candidate loci, CASP8 (rs1045485, rs17468277) and TGFB1 (rs1982073), were most strongly related with the risk of PR negative tumors (P = 5.1 x 10(-6) and P = 4.1 x 10(-4), respectively), as previously suggested. Four of the eight loci identified in GWAS were associated with triple negative tumors (P </= 0.016): rs3803662 (16q12), rs889312 (5q11), rs3817198 (11p15) and rs13387042 (2q35); however, only two of them (16q12 and 2q35) were associated with tumors with the core basal phenotype (P </= 0.002). These analyses are consistent with different biological origins of breast cancers, and indicate that tumor stratification might help in the identification and characterization of novel risk factors for breast cancer subtypes. This may eventually result in further improvements in prevention, early detection and treatment