Carolyn Nessim - Academia.edu (original) (raw)

Papers by Carolyn Nessim

Research paper thumbnail of The Development of a PCR genetic predictive tool for the response to hormone therapy in breast cancer

Research paper thumbnail of Desmoid Case Presentation with guest speaker Dr. Shreyaskumar Patel from MD Anderson

Research paper thumbnail of RETROPERITONEAL AND EXTREMITY SARCOMAS

Research paper thumbnail of Development of a multi-gene PCR assay for the prediction of the response to hormone therapy in breast cancer

Research paper thumbnail of Innovative Practice Model to optimize resource utilization and improve access to care for high-risk/BRCA+ breast cancer patients

BACKGROUND: Bilateral Prophylactic Mastectomy (BPM) has demonstrated survival benefit in high-ris... more BACKGROUND: Bilateral Prophylactic Mastectomy (BPM) has demonstrated survival benefit in high-risk/BRCA+ patients. 1,2 Increased awareness of genetic breast cancer, greater prevalence of genetic testing, and improvements in reconstruction techniques have created increased demand for BPM.

Research paper thumbnail of PERITONEAL SURFACE MALIGNANCIES

Research paper thumbnail of How Often do Level III Nodes Bear Melanoma Metastases and does it Affect Patient Outcomes?

BACKGROUND. Limited data exist regarding the necessity of resecting level three nodes as part of ... more BACKGROUND. Limited data exist regarding the necessity of resecting level three nodes as part of an axillary dissection for melanoma. The objective of this study was to determine how often level III nodes have metastases, in patients with sentinel lymph node (SLN) positive, palpable and bulky axillary disease, and to determine patient outcomes. METHODS. A retrospective chart review was completed at two tertiary care centres of patients with melanoma that had level three axillary dissections. At the time of surgery, the level III nodes were sent as a separate specimen. Bulky disease was defined as a large mass in all three levels that could not be separated. RESULTS. A total of 117 patients were identified. Three percent and 18 % of patients with SLN+ and palpable disease, respectively, had further disease in their level III nodes. All bulky patients had level III disease. Those with level III disease had a worse 3-year overall survival than those who did not (15.2 vs. 61.1 %, p< ...

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy?

INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing nu... more INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. METHODS: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a pCR...

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant chemotherapy? 0 Tumor Subtype ER + Her-2 + Triple

INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing nu... more INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. METHODS: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a pCR...

Research paper thumbnail of Princess Margaret Hospital Melanoma Guidelines

Research paper thumbnail of Wait times for Breast Cancer Surgery: Impact of MRI and Pre-operative Investigations on the Diagnostic Pathway

No funding was required for this project The authors do not have any disclosures to declare Categ... more No funding was required for this project The authors do not have any disclosures to declare Category: Original Article This paper was presented as a Poster at the American Society of Breast Surgeons 14 th Annual Meeting. Phoenix, Arizona, May 1-6, 2012. STRUCTURED ABSTRACT BACKGROUND Women with breast cancer often require an extensive diagnostic work-up.

Research paper thumbnail of Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway

Journal of oncology practice / American Society of Clinical Oncology, 2015

Women with breast cancer often require an extensive diagnostic work-up. We sought to determine th... more Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer. A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described. Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive ...

Research paper thumbnail of Surgical Site Infection Prevention: A Qualitative Analysis of an Individualized Audit and Feedback Model

Journal of the American College of Surgeons, 2012

BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care cost... more BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention. STUDY DESIGN: This study was performed in a tertiary care center, based on patients treated in the colorectal and hepatic-pancreatic-biliary surgical oncology services. Eighteen clinicians were interviewed. Analysis of interviews via comparative analysis techniques and coding strategies were used to identify themes.

Research paper thumbnail of How Often do Level III Nodes Bear Melanoma Metastases and does it Affect Patient Outcomes?

Annals of Surgical Oncology, 2013

Background. Limited data exist regarding the necessity of resecting level three nodes as part of ... more Background. Limited data exist regarding the necessity of resecting level three nodes as part of an axillary dissection for melanoma. The objective of this study was to determine how often level III nodes have metastases, in patients with sentinel lymph node (SLN) positive, palpable and bulky axillary disease, and to determine patient outcomes. Methods. A retrospective chart review was completed at two tertiary care centers of patients with melanoma that had level three axillary dissections. At the time of surgery, the level III nodes were sent as a separate specimen. Bulky disease was defined as a large mass in all three levels that could not be separated. Results. A total of 117 patients were identified. Three percent and 18 % of patients with SLN? and palpable disease, respectively, had further disease in their level III nodes. All bulky patients had level III disease. Those with level III disease had a worse 3-year overall survival than those who did not (15.2 vs. 61.1 %, p \ 0.001). For patients with palpable and bulky disease, systemic recurrence rate was 65 and 88 %, with a median time to metastases of 13.6 and 2 months, respectively. Conclusions. Patients with SLN? disease rarely have positive level III nodes, questioning the need for routine removal of these nodes. Patients with palpable and bulky lymph node disease have implied occult distant metastases at the time of diagnosis and treatment. With the advent of improved targeted therapies for melanoma, clinical trials evaluating their role in patients with stage III disease may be warranted to improve patient outcomes.

Research paper thumbnail of The effect of fluid overload in the presence of an epidural on the strength of colonic anastomoses

Journal of Surgical Research, 2013

Colon Epidural Fluid overload Crystalloid Colloid Colonic anastomoses Fluid balance Sympathetic b... more Colon Epidural Fluid overload Crystalloid Colloid Colonic anastomoses Fluid balance Sympathetic block Euvolemia a b s t r a c t Background: Despite the beneficial effects of epidurals in intra-abdominal surgery, the incidence of anastomotic leak remains controversial when used. Moreover, studies have also shown that fluid overload may be deleterious to anastomoses. The purpose of this paper is to evaluate the effects of varying intraoperative fluid protocols, in the presence of an epidural, on the burst pressure strength of colonic anastomoses. Methods: An epidural was installed in 18 rabbits, divided into three groups. Group 1 received 30 mL/kg/h Ringer's lactate, Group 2 received 100 mL/kg/h Ringer's lactate, and Group 3 received 30 mL/kg/h Pentaspan. Two colo-colonic anastomoses were performed per rabbit.

Research paper thumbnail of The Development of a PCR genetic predictive tool for the response to hormone therapy in breast cancer

Research paper thumbnail of Desmoid Case Presentation with guest speaker Dr. Shreyaskumar Patel from MD Anderson

Research paper thumbnail of RETROPERITONEAL AND EXTREMITY SARCOMAS

Research paper thumbnail of Development of a multi-gene PCR assay for the prediction of the response to hormone therapy in breast cancer

Research paper thumbnail of Innovative Practice Model to optimize resource utilization and improve access to care for high-risk/BRCA+ breast cancer patients

BACKGROUND: Bilateral Prophylactic Mastectomy (BPM) has demonstrated survival benefit in high-ris... more BACKGROUND: Bilateral Prophylactic Mastectomy (BPM) has demonstrated survival benefit in high-risk/BRCA+ patients. 1,2 Increased awareness of genetic breast cancer, greater prevalence of genetic testing, and improvements in reconstruction techniques have created increased demand for BPM.

Research paper thumbnail of PERITONEAL SURFACE MALIGNANCIES

Research paper thumbnail of How Often do Level III Nodes Bear Melanoma Metastases and does it Affect Patient Outcomes?

BACKGROUND. Limited data exist regarding the necessity of resecting level three nodes as part of ... more BACKGROUND. Limited data exist regarding the necessity of resecting level three nodes as part of an axillary dissection for melanoma. The objective of this study was to determine how often level III nodes have metastases, in patients with sentinel lymph node (SLN) positive, palpable and bulky axillary disease, and to determine patient outcomes. METHODS. A retrospective chart review was completed at two tertiary care centres of patients with melanoma that had level three axillary dissections. At the time of surgery, the level III nodes were sent as a separate specimen. Bulky disease was defined as a large mass in all three levels that could not be separated. RESULTS. A total of 117 patients were identified. Three percent and 18 % of patients with SLN+ and palpable disease, respectively, had further disease in their level III nodes. All bulky patients had level III disease. Those with level III disease had a worse 3-year overall survival than those who did not (15.2 vs. 61.1 %, p< ...

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy?

INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing nu... more INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. METHODS: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a pCR...

Research paper thumbnail of Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant chemotherapy? 0 Tumor Subtype ER + Her-2 + Triple

INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing nu... more INTRODUCTION: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. METHODS: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a pCR...

Research paper thumbnail of Princess Margaret Hospital Melanoma Guidelines

Research paper thumbnail of Wait times for Breast Cancer Surgery: Impact of MRI and Pre-operative Investigations on the Diagnostic Pathway

No funding was required for this project The authors do not have any disclosures to declare Categ... more No funding was required for this project The authors do not have any disclosures to declare Category: Original Article This paper was presented as a Poster at the American Society of Breast Surgeons 14 th Annual Meeting. Phoenix, Arizona, May 1-6, 2012. STRUCTURED ABSTRACT BACKGROUND Women with breast cancer often require an extensive diagnostic work-up.

Research paper thumbnail of Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway

Journal of oncology practice / American Society of Clinical Oncology, 2015

Women with breast cancer often require an extensive diagnostic work-up. We sought to determine th... more Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer. A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described. Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive ...

Research paper thumbnail of Surgical Site Infection Prevention: A Qualitative Analysis of an Individualized Audit and Feedback Model

Journal of the American College of Surgeons, 2012

BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care cost... more BACKGROUND: Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention. STUDY DESIGN: This study was performed in a tertiary care center, based on patients treated in the colorectal and hepatic-pancreatic-biliary surgical oncology services. Eighteen clinicians were interviewed. Analysis of interviews via comparative analysis techniques and coding strategies were used to identify themes.

Research paper thumbnail of How Often do Level III Nodes Bear Melanoma Metastases and does it Affect Patient Outcomes?

Annals of Surgical Oncology, 2013

Background. Limited data exist regarding the necessity of resecting level three nodes as part of ... more Background. Limited data exist regarding the necessity of resecting level three nodes as part of an axillary dissection for melanoma. The objective of this study was to determine how often level III nodes have metastases, in patients with sentinel lymph node (SLN) positive, palpable and bulky axillary disease, and to determine patient outcomes. Methods. A retrospective chart review was completed at two tertiary care centers of patients with melanoma that had level three axillary dissections. At the time of surgery, the level III nodes were sent as a separate specimen. Bulky disease was defined as a large mass in all three levels that could not be separated. Results. A total of 117 patients were identified. Three percent and 18 % of patients with SLN? and palpable disease, respectively, had further disease in their level III nodes. All bulky patients had level III disease. Those with level III disease had a worse 3-year overall survival than those who did not (15.2 vs. 61.1 %, p \ 0.001). For patients with palpable and bulky disease, systemic recurrence rate was 65 and 88 %, with a median time to metastases of 13.6 and 2 months, respectively. Conclusions. Patients with SLN? disease rarely have positive level III nodes, questioning the need for routine removal of these nodes. Patients with palpable and bulky lymph node disease have implied occult distant metastases at the time of diagnosis and treatment. With the advent of improved targeted therapies for melanoma, clinical trials evaluating their role in patients with stage III disease may be warranted to improve patient outcomes.

Research paper thumbnail of The effect of fluid overload in the presence of an epidural on the strength of colonic anastomoses

Journal of Surgical Research, 2013

Colon Epidural Fluid overload Crystalloid Colloid Colonic anastomoses Fluid balance Sympathetic b... more Colon Epidural Fluid overload Crystalloid Colloid Colonic anastomoses Fluid balance Sympathetic block Euvolemia a b s t r a c t Background: Despite the beneficial effects of epidurals in intra-abdominal surgery, the incidence of anastomotic leak remains controversial when used. Moreover, studies have also shown that fluid overload may be deleterious to anastomoses. The purpose of this paper is to evaluate the effects of varying intraoperative fluid protocols, in the presence of an epidural, on the burst pressure strength of colonic anastomoses. Methods: An epidural was installed in 18 rabbits, divided into three groups. Group 1 received 30 mL/kg/h Ringer's lactate, Group 2 received 100 mL/kg/h Ringer's lactate, and Group 3 received 30 mL/kg/h Pentaspan. Two colo-colonic anastomoses were performed per rabbit.