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Loretta Loftus, Christine Laronga, Karen Coyne, and Lynne Hildreth

Analysis of Moffitt Cancer Center data on time from breast biopsy to first definitive surgery showed an average of 6.9 weeks, which concerned the breast program faculty members. Delays in curative surgery may impact mortality, quality of life, and time to adjuvant therapy. The purpose of this study was to analyze steps from breast biopsy to definitive breast cancer surgery and to develop proposals and strategies for improvement. Data were collected from various sources, including the tumor registry, patient appointment system, tumor board lists, and the NCCN Oncology Outcomes Database for Breast Cancer. Three phases of the surgical process were identified with regard to lead time: biopsy to first consult (BX-FC); first consult to tumor board (FC-TB); and tumor board to surgery (TB-SU). Other factors, including operating room capacity and schedules, were also evaluated. The greatest percentage of total lead time occurred in the TB-SU phase (52% vs 35% in BX-FC, and 13% in FC-TB phases). The longest average lead time, 3.6 weeks, was also in the TB-SU phase. The TB-SU time was greatest when surgery was scheduled after tumor board and if surgery required breast reconstruction. Limitation of physician capacity was a major factor in treatment delay. The Opportunity for Improvement project enabled institutional analysis of the need for quality improvement in time for curative surgery for breast cancer. A significant factor that created time delay was physician capacity. As a result, additional faculty and staff have been recruited. A new expanded facility is currently in progress that will provide more physical space and services.

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Philip Sobash and Nagla Abdel Karim

atypical disease and metastatic disease. Aim of the study is to explore the benefit of adjuvant therapy for thoracic carcinoid tumors. Methods: A literature review was conducted through PubMed in accordance with PRISMA guidelines to identify studies

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of capecitabine + oxaliplatin was added as an option in adjuvant therapy with a category 2A designation. Footnote “j” was clarified by adding “exclusive of those cancers that are MSI-H” to grade 3-4. Surveillance Chest

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Al B. Benson III, Tanios Bekaii-Saab, Emily Chan, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Paul F. Engstrom, Peter C. Enzinger, Marwan G. Fakih, Moon J. Fenton, Charles S. Fuchs, Jean L. Grem, Steven Hunt, Ahmed Kamel, Lucille A. Leong, Edward Lin, Kilian Salerno May, Mary F. Mulcahy, Kate Murphy, Eric Rohren, David P. Ryan, Leonard Saltz, Sunil Sharma, David Shibata, John M. Skibber, William Small Jr, Constantinos T. Sofocleous, Alan P. Venook, Christopher G. Willett, Kristina M. Gregory, and Deborah A. Freedman-Cass

rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Adjuvant Therapy for Stage II Disease The panel discussed the impact of adjuvant chemotherapy on

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scientific peer-review process and are overseen by the ORP. An NCCN study funded through the grant mechanism is highlighted below. Randomized Phase II Study Comparing Concise (3 Months) Versus Prolonged (2 Years) Afatinib as Adjuvant Therapy for

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Tiffany H. Svahn, Joyce C. Niland, Robert W. Carlson, Melissa E. Hughes, Rebecca A. Ottesen, Richard L. Theriault, Stephen B. Edge, Anne F. Schott, Michael A. Bookman, and Jane C. Weeks

. 5 Coates AS Keshaviah A Thurlimann B . Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98 . J Clin Oncol 2007 ; 25 : 486

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Nora M. Hansen, Sally Anne Scherer, and Seema Khan

of 60 cases, care was nonconcordant in 8. Among those cases, 1 patient was advised to have chemotherapy but refused; another patient’s record did not document a recommendation for adjuvant therapy; and 5 patients received treatment but not within the

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Margaret Tempero

margin,” she said. Dr. Tempero briefly reviewed some of the representative adjuvant therapy clinical trials conducted in pancreatic cancer, focusing primarily on the relatively recent phase III ESPAC-4 trial of gemcitabine/capecitabine 1 and the

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Margaret Tempero

reason that in the adjuvant setting, we could probably identify diagnostic tools to predict outcome, and thus need for adjuvant treatment, across all disease sites. Actually, folks are working on that with a fair bit of success. But adjuvant therapy is

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Michaela J. Higgins, James M. Rae, David A. Flockhart, Daniel F. Hayes, and Vered Stearns

adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial . Lancet Oncol 2008 ; 9 : 45 – 53 . 48 Coates AS Keshaviah A Thurlimann B . Five years of letrozole compared with tamoxifen as initial adjuvant therapy for