Jennifer Plichta

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Depauw University

M.D. 2008

Indiana University, School of Medicine

M.S. 2012

Loyola University Medical Center

General Surgery Resident, Surgery

Loyola University Medical Center

Breast Surgery Fellowship, Surgery

Brigham and Women's Hospital

Breast Surgery Fellowship, Surgery

Dana-Farber Cancer Institute

Breast Surgery Fellowship, Surgery

Massachusetts General Hospital

Grants:

Publications:

Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery: How Low is "Low Risk"?

BACKGROUND: Breast surgery carries a low risk of postoperative mortality. For older patients with multiple comorbidities, even low-risk procedures can confer some increased perioperative risk. We sought to identify factors associated with postoperative mortality in breast cancer patients ≥70 years to create a nomogram for predicting risk of death within 90 days. METHODS: Patients diagnosed with nonmetastatic invasive breast cancer (2010-2016) were selected from the National Cancer Database. Unadjusted OS was estimated using the Kaplan-Meier method. Multivariate logistic regression was used to estimate the association of age and surgery with 90-day mortality and to build a predictive nomogram. RESULTS: Among surgical patients ≥70 years, unadjusted 90-day mortality increased with increasing age (70-74 = 0.4% vs. ≥85 = 1.6%), comorbidity score (0 = 0.5% vs. ≥3 = 2.7%), and disease stage (I = 0.4% vs. III = 2.7%; all p < 0.001). After adjustment, death within 90 days of surgery was associated with higher age (≥85 vs. 70-74: odds ratio [OR] 3.16, 95% confidence interval [CI] 2.74-3.65), comorbidity score (≥3 vs. 0: OR 4.79, 95% CI 3.89-5.89), and disease stage (III vs. I: OR 4.30, 95% CI 3.69-5.00). Based on these findings, seven variables (age, gender, comorbidity score, facility type, facility location, clinical stage, and surgery type) were selected to build a nomogram; estimates of risk of death within 90 days ranged from <1 to >30%. CONCLUSIONS: Breast operations remain relatively low-risk procedures for older patients with breast cancer, but select factors can be used to estimate the risk of postoperative mortality to guide surgical decision-making among older women.
MLA Citation
Dillon, Jacquelyn, et al. “Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery: How Low is "Low Risk"?Ann Surg Oncol, vol. 28, no. 10, 2021, pp. 5758–67. Pubmed, doi:10.1245/s10434-021-10502-3.
URI
https://scholars.duke.edu/individual/pub1483069
PMID
34309779
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
5758
End Page
5767
DOI
10.1245/s10434-021-10502-3

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

<h4>Background</h4>Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.<h4>Methods</h4>This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.<h4>Results</h4>Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas.<h4>Conclusion</h4>Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.
Authors
COVIDSurg Collaborative,
MLA Citation
COVIDSurg Collaborative, Christopher S. “Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.The British Journal of Surgery, vol. 108, no. 1, Jan. 2021, pp. 88–96. Epmc, doi:10.1093/bjs/znaa051.
URI
https://scholars.duke.edu/individual/pub1481716
PMID
33640908
Source
epmc
Published In
British Journal of Surgery
Volume
108
Published Date
Start Page
88
End Page
96
DOI
10.1093/bjs/znaa051

Breast cancer prognostic staging and internal mammary lymph node metastases: a brief overview.

Authors
MLA Citation
Plichta, Jennifer K. “Breast cancer prognostic staging and internal mammary lymph node metastases: a brief overview.Chin Clin Oncol, vol. 8, no. S1, Oct. 2019, p. S11. Pubmed, doi:10.21037/cco.2019.01.09.
URI
https://scholars.duke.edu/individual/pub1483721
PMID
31684732
Source
pubmed
Published In
Chin Clin Oncol
Volume
8
Published Date
Start Page
S11
DOI
10.21037/cco.2019.01.09

Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer?

BACKGROUND: Contralateral axillary nodal metastases (CAM) is classified as stage IV disease, although many centers treat CAM with curative intent. We hypothesized that patients with CAM, treated with multimodality therapy, would have improved overall survival (OS) versus patients with distant metastatic disease (M1) and similar OS to those with locally advanced breast cancer (LABC). METHODS: Using the NCDB (2004-2016), we categorized adult patients with node-positive breast cancer into three study groups: LABC, CAM, and M1. Kaplan-Meier curves were used to visualize the unadjusted OS. Cox proportional hazards models were used to estimate the association of study group with OS. RESULTS: A total of 94,487 patients were identified: 122 with CAM, 12,325 with LABC, and 82,040 with M1 (median follow-up 63.6 months). LABC and CAM patients had similar histology and rates of chemotherapy and endocrine therapy receipt. However, the CAM group had significantly larger tumors, more estrogen-receptor expression, higher T-stage, and more mastectomies than the LABC group. Compared with M1 patients, CAM patients were more likely to have grade 3 and cT4 tumors. Patients with CAM and LABC had similar 5-year unadjusted OS and significantly improved OS vs M1 patients. After adjustment, LABC and CAM patients continued to have similar OS and better OS vs M1 patients. CONCLUSIONS: CAM patients who receive multi-modal therapy with curative intent may have OS more comparable to LABC patients than M1 patients. Out data support a reevaluation of whether CAM should remain classified as M1, as N3 may better reflect disease prognosis and treatment goals.
Authors
MLA Citation
Nash, Amanda L., et al. “Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer?Ann Surg Oncol, vol. 28, no. 10, 2021, pp. 5544–52. Pubmed, doi:10.1245/s10434-021-10461-9.
URI
https://scholars.duke.edu/individual/pub1483070
PMID
34287787
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
5544
End Page
5552
DOI
10.1245/s10434-021-10461-9

Mobile Health Application for Patients Undergoing Breast Cancer Surgery: Feasibility Study.

PURPOSE: Contemporary breast cancer surgery often requires hospital stays of 1 day or less, presenting challenges to delivery of high-quality care. Without sufficient time for proper education and guidance, patients may delay seeking care, experience anxiety, or seek unnecessary care, leading to poorer outcomes and increased costs. To address this, we evaluated the feasibility of a planning-, outcomes-, and analytics-based mobile health application called Manage My Surgery (MMS) for patients undergoing elective breast cancer surgery. METHODS: Patients undergoing breast cancer surgery at an academic health center were invited to use MMS. Those who used the application received pre- and postoperative surveys, which recorded and reported patient satisfaction and outcomes related to the application. RESULTS: Thirty-three female patients undergoing elective breast cancer surgery used MMS. The median age was 58 years. Nineteen patients underwent lumpectomy, and 14 underwent mastectomy. Users logged on to the application an average of 3.5 times. The median number of questions viewed was 12 (range 2-35). Of 17 patients who completed the feedback survey, 100% said that MMS was helpful during preparation for surgery, 82.3% said that MMS was helpful postoperatively, and 94.1% would recommend MMS to others. Preliminary data on patient-reported outcomes collected by MMS suggest improvements in anxiety and depression over time. CONCLUSION: Implementation of a digital care navigation tool in breast cancer surgery patients is feasible. Patients found the tool helpful in both the pre- and postoperative period. Additional ongoing work will focus on patients' self-management skills, long-term outcomes, and health system costs.
Authors
Ponder, M; Venkatraman, V; Charalambous, L; Ansah-Yeboah, AA; Adil, SM; Antezana, LA; Dharmapurikar, R; Gellad, ZF; Lad, SP; Hwang, ES; Plichta, JK
MLA Citation
Ponder, Madison, et al. “Mobile Health Application for Patients Undergoing Breast Cancer Surgery: Feasibility Study.Jco Oncol Pract, vol. 17, no. 9, Sept. 2021, pp. e1344–53. Pubmed, doi:10.1200/OP.20.01026.
URI
https://scholars.duke.edu/individual/pub1484539
PMID
34097502
Source
pubmed
Published In
Jco Oncol Pract
Volume
17
Published Date
Start Page
e1344
End Page
e1353
DOI
10.1200/OP.20.01026