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Montella L, Di Marino L, Marino MA, Riccio V, Del Gaudio N, Altucci L, Berretta M, Facchini G. Case report: An ultrasound-based approach as an easy tool to evaluate hormone receptor-positive HER-2-negative breast cancer in advanced/metastatic settings: preliminary data of the Plus-ENDO study. Front Oncol 2024; 14:1295772. [PMID: 38690171 PMCID: PMC11058846 DOI: 10.3389/fonc.2024.1295772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
Background Hormone receptor-positive tumors are unlikely to exhibit a complete pathological tumor response. The association of CDK 4/6 inhibitor plus hormone therapy has changed this perspective. Case presentation In this study, we retrospectively reviewed the charts of patients with a diagnosis of luminal A/B advanced/metastatic tumors treated with a CDK 4/6 inhibitor-based therapy. In this part of the study, we present clinical and ultrasound evaluation. Eight female patients were considered eligible for the study aims. Three complete and five partial responses were reported, including a clinical tumor response of 50% or more in five out of nine assessed lesions (55%). All patients showed a response on ultrasound. The mean lesion size measured by ultrasound was 27.1 ± 15.02 mm (range, 6-47 mm) at the baseline; 16.08 ± 14.6 mm (range, 0-40 mm) after 4 months (T1); and 11.7 ± 12.9 mm (range, 0-30 mm) at the 6 months follow-up (T2). Two patients underwent surgery. The radiological complete response found confirmation in a pathological complete response, while the partial response matched a moderate residual disease. Conclusion The evaluation of breast cancer by ultrasound is basically informative of response and may be an easy and practical tool to monitor advanced tumors, especially in advanced/unfit patients who are reluctant to invasive exams.
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Affiliation(s)
- Liliana Montella
- Oncology Operative Unit, “Santa Maria delle Grazie” Hospital, ASL Napoli 2 NORD, Pozzuoli, Italy
| | | | | | | | - Nunzio Del Gaudio
- Department of Precision Medicine, “Luigi Vanvitelli” University of Campania, Napoli, Italy
| | - Lucia Altucci
- Department of Precision Medicine, “Luigi Vanvitelli” University of Campania, Napoli, Italy
- Molecular Biology and Genetics Research Institute, Biogem, Ariano Irpino, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gaetano Facchini
- Oncology Operative Unit, “Santa Maria delle Grazie” Hospital, ASL Napoli 2 NORD, Pozzuoli, Italy
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Zheng H, Yang L, Hu J, Yang Y. Behaviour, barriers and facilitators of shared decision making in breast cancer surgical treatment: A qualitative systematic review using a 'Best Fit' framework approach. Health Expect 2024; 27:e14019. [PMID: 38558230 PMCID: PMC10982676 DOI: 10.1111/hex.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Due to the diversity and high sensitivity of the treatment, there were difficulties and uncertainties in the breast cancer surgical decision-making process. We aimed to describe the patient's decision-making behaviour and shared decision-making (SDM)-related barriers and facilitators in breast cancer surgical treatment. METHODS We searched eight databases for qualitative studies and mixed-method studies about breast cancer patients' surgical decision-making process from inception to March 2021. The quality of the studies was critically appraised by two researchers independently. We used a 'best fit framework approach' to analyze and synthesize the evidence. RESULTS Twenty-eight qualitative studies and three mixed-method studies were included in this study. Four themes and 10 subthemes were extracted: (a) struggling with various considerations, (b) actual decision-making behaviours, (c) SDM not routinely implemented and (d) multiple facilitators and barriers to SDM. CONCLUSIONS Patients had various considerations of breast surgery and SDM was not routinely implemented. There was a discrepancy between information exchange behaviours, value clarification, decision support utilization and SDM due to cognitive and behavioural biases. When individuals made surgical decisions, their behaviours were affected by individual-level and system-level factors. Therefore, healthcare providers and other stakeholders should constantly improve communication skills and collaboration, and emphasize the importance of decision support, so as to embed SDM into routine practice. PATIENT AND PUBLIC CONTRIBUTION This systematic review was conducted as part of a wider research entitled: Breast cancer patients' actual participation roles in surgical decision making: a mixed method research. The results of this project helped us to better analyze and generalize patients' views.
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Affiliation(s)
- Hongying Zheng
- School of Nursing, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Linning Yang
- School of Nursing, School of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Jiale Hu
- Department of Nurse Anesthesia, College of Health ProfessionsVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Yan Yang
- Department of Nursing, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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3
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Torrisi C, Wareg NK, Anbari AB. Decision-making for bilateral risk-reducing mastectomy for an increased lifetime breast cancer risk: A qualitative metasynthesis. Psychooncology 2024; 33:e6311. [PMID: 38429973 DOI: 10.1002/pon.6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but without an actual cancer diagnosis. Previvorship entails the selection of risk management strategies. For women with a genetic mutation that increases their predisposition for a breast cancer diagnosis, bilateral risk-reducing mastectomy (BRRM) is the most effective prevention strategy. However, BRRM can change a woman's breast appearance and function. The purpose of this qualitative metasynthesis (QMS) was to better understand the decision-making process for BRRM among previvors. METHODS A theory-generating QMS approach was used to analyze and synthesize qualitative findings. Research reports were considered for inclusion if: (1) women over 18 years of age possessed a genetic mutation increasing lifetime breast cancer risk or a strong family history of breast cancer; (2) the sample was considering, or had completed, BRRM; (3) the results reported qualitative findings. Exclusion criteria were male gender, personal history of breast cancer, and research reports which did not separate findings based on cancer diagnosis and/or risk-reduction surgery. RESULTS A theory and corresponding model emerged, comprised of seven themes addressing the decision-making process for or against BRRM. While some factors to decision-making were decisive for surgery, others were more indefinite and contributed to women changing, processing, or suspending their decision-making for a period of time. CONCLUSIONS Regardless of the decision previvors make about BRRM, physical and psychosocial well-being should be considered and promoted through shared decision-making in the clinical setting.
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Affiliation(s)
- Christa Torrisi
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Nuha K Wareg
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Allison Brandt Anbari
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
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Vrancken Peeters NJMC, Vlooswijk C, Bijlsma RM, Kaal SEJ, Kerst JM, Tromp JM, Bos MEMM, van der Hulle T, Lalisang RI, Nuver J, Kouwenhoven MCM, van der Ploeg IMC, van der Graaf WTA, Husson O. Sexual quality of life of adolescents and young adult breast cancer survivors. ESMO Open 2024; 9:102234. [PMID: 38281325 PMCID: PMC10937205 DOI: 10.1016/j.esmoop.2024.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND With increasing survival rates of adolescents and young adults (AYAs) with breast cancer, health-related quality of life (HRQoL) becomes more important. An important aspect of HRQoL is sexual QoL. This study examined long-term sexual QoL of AYA breast cancer survivors, compared sexual QoL scores with that of other AYA cancer survivors, and identified factors associated with long-term sexual QoL of AYA breast cancer survivors. MATERIALS AND METHODS Data of the SURVAYA study were utilized for secondary analyses. Sexual QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). Descriptive statistics were used to describe sexual QoL of AYA cancer survivors. Linear regression models were constructed to examine the effect of cancer type on sexual QoL and to identify factors associated with sexual QoL. RESULTS Of the 4010 AYA cancer survivors, 944 had breast cancer. Mean sexual QoL scores of AYA breast cancer survivors ranged from 34.5 to 60.0 for functional domains and from 25.2 to 41.5 for symptom-orientated domains. AYA breast cancer survivors reported significantly lower sexual QoL compared to AYA survivors of other cancer types on all domains. Age, time since diagnosis, relationship status, educational level, chemotherapy, hormonal therapy, breast surgery, body image, and coping were associated with sexual QoL of AYA breast cancer survivors. CONCLUSIONS AYA breast cancer survivors experience decreased sexual QoL in the long term (5-20 years) after diagnosis and worse score compared to AYA survivors of other cancer types, indicating a clear need to invest in supportive care interventions for those at risk, to enhance sexual well-being.
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Affiliation(s)
- N J M C Vrancken Peeters
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - C Vlooswijk
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht
| | - R M Bijlsma
- Department of Medical Oncology, University Medical Centre, Utrecht
| | - S E J Kaal
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen
| | - J M Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - J M Tromp
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam
| | - M E M M Bos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - T van der Hulle
- Department of Medical Oncology, Leiden University Medical Centre, Leiden
| | - R I Lalisang
- Department of Internal Medicine, Division of Medical Oncology, GROW-School of Oncology and Reproduction, Maastricht UMC+ Comprehensive Cancer Centre, Maastricht
| | - J Nuver
- Department of Medical Oncology, University Medical Centre Groningen, Groningen
| | - M C M Kouwenhoven
- Department of Neurology, Amsterdam UMC, Amsterdam University Medical Centres, Amsterdam
| | - I M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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5
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Fefferman M, Kuchta K, Nicholson K, Attai D, Victorson D, Pesce C, Kopkash K, Poli E, Smith TW, Yao K. Patient values in breast cancer surgical decision-making - The WhySurg study. Am J Surg 2024; 227:137-145. [PMID: 37858372 DOI: 10.1016/j.amjsurg.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/17/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The objective of this study was to describe patient values and personality traits associated with breast surgery choice for patients with breast cancer. METHODS A survey based on qualitative patient interviews and the Big-Five personality trait profile was distributed to Love Research Army volunteers aged 18-70 years old who underwent breast cancer surgery from 2009 to 2020. Multivariable logistic regression analysis was used to determine independent patient values and personality traits for the choice of breast-conserving surgery (BCS), unilateral mastectomy (UM) and bilateral mastectomy (BM). RESULTS 1497 participants completed the survey. Open-mindedness was associated with UM and sociability was associated with BM. A majority of patients prioritized cancer outcomes. Compared to BM patients, BCS and UM patients were significantly more likely to choose values associated with maintaining their self-image, optimizing surgical recovery, and following their doctor's recommendation. CONCLUSIONS Other values besides cancer outcomes differentiate patient surgical choice for BCS or mastectomy.
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Affiliation(s)
- Marie Fefferman
- Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Kristine Kuchta
- Biostatistical Core, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Kyra Nicholson
- Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Deanna Attai
- Department of Surgery, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University, 633 Clark St, Evanston, IL, 60208, USA
| | - Catherine Pesce
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Katherine Kopkash
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Elizabeth Poli
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Thomas W Smith
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Katharine Yao
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
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Murray A, Francks L, Hassanein ZM, Lee R, Wilson E. Breast cancer surgical decision-making. Experiences of Non-Caucasian women globally. A qualitative systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107109. [PMID: 37866153 DOI: 10.1016/j.ejso.2023.107109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES To perform a qualitative systematic review exploring the influencing factors within the surgical decision-making (SDM) processes following a breast cancer diagnosis in non-caucasian women globally. STUDY DESIGN Qualitative systemic review following PRISMA guidelines. METHODS A comprehensive search strategy was applied to four databases. 5243 papers were screened using a composed inclusion and exclusion criteria resulting in 10 total papers to be included. These papers underwent JBI quality assessment and ConQual assessment to ensure strength in validation, reliability, and quality. RESULTS Six main overarching themes relating to SDM were determined: fear, information, patient-doctor relationship, wellbeing, external influences, and culture. All ethnicities experienced fear in one way. Misinformation was widely experienced in concordance with either a lack of education (Iranian and Ghanian women) or language barriers (immigrant populations). Trust was overarching in all patient-doctor relationships, some being overshadowed by an authoritative dynamic in Ghanian and Iranian women. Well-being, both psychological and body image was noted in all but the Ghanian and Iranian women. Every ethnicity experienced external influences involving either others, time or cost. Lastly, cultural expectations and beliefs of the doctor was present in all native or immigrant Asian communities. CONCLUSIONS The study identified several factors which were common between ethnicities, notably multifactorial fear, well-being factors, opinions and trust of others, and timing. Conversely, information availability and the nature of patient-doctor relationships varied widely between ethnicities. The study has identified some realistic and achievable focus areas for practice improvement, but also notes the challenges of changing long-established cultural norms.
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Affiliation(s)
- Annabel Murray
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Lucy Francks
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Zeinab M Hassanein
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Assiut University, Assiut, Egypt
| | - Rachel Lee
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Emma Wilson
- Nottingham Centre for Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Centre for Evidence-Based Healthcare, University of Nottingham, United Kingdom; Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, United Kingdom
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7
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Li Z, Liu Y, Zhang J, Li Y, Du K, Zhang S, Han H, Zhang J. A large single-center prospective study to investigate the factors influencing the choice of breast-conserving surgery versus mastectomy in Chinese women with early breast cancer. World J Surg Oncol 2023; 21:43. [PMID: 36765355 PMCID: PMC9921411 DOI: 10.1186/s12957-023-02924-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Compared to mastectomy, breast-conserving surgery (BCS) provides the same survival rate and a higher quality of life for patients with early breast cancer (EBC). However, Chinese women with EBC are known to have a low BCS rate. A large prospective cohort study was conducted to investigate the factors influencing the choice of BCS in this population. METHODS In 2017, all women with unilateral EBC and eligible for BCS at our institution were enrolled. Before surgery, the patient's trust in the surgeon and her perceived strength of the surgeon's recommendation of BCS were measured through an in-person interview and validated ad hoc questionnaire. Multivariate logistic regressions on BCS procedure vs. mastectomy were used to estimate the odds ratio (OR). RESULTS One thousand one hundred thirty-six patients enrolled at analysis had an average age of 51.8 and tumor size of 2.4 cm. 19.9% of patients had BCS. The "strong" level of trust in the surgeon was significantly associated with BCS with an OR of 2.944 (p<0.001) when compared to the "average or under" trust. The "strong" and "moderate" strengths in surgeon recommendation for BCS were also found to be significantly associated with the BCS procedure with ORs of 12.376 (p <0.001) and 1.757 (p =0.040), respectively, compared to the "neutral or dissuaded" strength. CONCLUSIONS Stronger trust in surgeons and BCS recommendation by surgeons are associated with a higher rate of BCS in Chinese women with EBC. Interventional trials are needed to confirm this finding.
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Affiliation(s)
- Zhensheng Li
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035, China.
| | - Yunjiang Liu
- Department of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035, China.
| | - Jing Zhang
- grid.452582.cDepartment of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Yue Li
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Kaiye Du
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Shuo Zhang
- grid.452582.cDepartment of Breast Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Huina Han
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
| | - Jun Zhang
- grid.452582.cDepartment of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050035 China
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Veličković K, Borrebaeck CAK, Bendahl PO, Hegardt C, Johnsson P, Richter C, Rydén L, Hallberg IR. One-year recovery from breast cancer: Importance of tumor and treatment-related factors, resilience, and sociodemographic factors for health-related quality of life. Front Oncol 2022; 12:891850. [PMID: 36052232 PMCID: PMC9425776 DOI: 10.3389/fonc.2022.891850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
AimThis study investigated the changes in health-related quality of life from diagnosis to 1 year after diagnosis in breast cancer (BC) patients and the influence of clinical, psychological, and sociodemographic variables. An additional aim was to explore the mediating and moderating effects of resilience on changes in health-related quality of life.MethodsA longitudinal population-based study was conducted in southern Sweden. Newly diagnosed BC patients filled in measures of health-related quality of life, resilience, and sociodemographic variables at diagnosis (N = 980) and 1 year post-diagnosis (N = 780). Clinical variables were extracted from the Swedish national breast cancer quality registry. Mixed-model analyses were performed.ResultsMost health-related quality of life outcomes declined from diagnosis to 1 year post-diagnosis. Role limitations due to emotional problems remained the same, whereas mental health improved. Lower health-related quality of life outcomes were associated with symptomatic detection and axillary dissection. Patients with a higher TNM stage and histologic grade and estrogen receptor (ER)-negative and human epidermal growth factor 2 (HER2)-positive status, who received chemotherapy, antibody therapy, or bisphosphonate therapy, had a steeper decline in outcomes. Changes in resilience were positively associated with all outcomes but did not mediate or moderate changes in any. Resilience at baseline moderated changes in bodily pain, vitality, and mental health, with higher baseline resilience being associated with a steeper decline, possibly due to floor or ceiling effects. Patients with lower socioeconomic status, educational level, and older age had a lower health-related quality of life.ConclusionPhysical health-related quality of life among breast cancer patients declined 1 year post-diagnosis, whereas mental health-related quality of life improved. Low resilient patients may be especially vulnerable at diagnosis. Biopsychosocial assessment at diagnosis can help identify patients who may require additional support. A multidimensional treatment plan should be started early to help overcome the problems in everyday activities.
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Affiliation(s)
- Katarina Veličković
- Department of Psychology, Lund University, Lund, Sweden
- *Correspondence: Katarina Veličković,
| | - Carl A. K. Borrebaeck
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Cecilia Hegardt
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
| | - Corinna Richter
- Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Lund, Sweden
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Fazeli S, Snyder BS, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis CA, Corsetti RL, Rahbar H, Spell DW, Blankstein KB, Han LK, Sabol JL, Bumberry JR, Miller KD, Sparano JA, Comstock CE, Wagner LI, Carlos RC. Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open 2022; 5:e2210331. [PMID: 35536580 PMCID: PMC9092204 DOI: 10.1001/jamanetworkopen.2022.10331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. Objective To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. Design, Setting, and Participants A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Exposures Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Main Outcomes and Measures Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Results Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P < .001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P < .001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P < .001). Conclusions and Relevance In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California San Diego, San Diego
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Seema A. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine A. Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ralph L. Corsetti
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle
| | | | | | - Linda K. Han
- Department of Surgery, Indiana University, Indianapolis
| | - Jennifer L. Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - John R. Bumberry
- Department of Surgery, Mercy Hospital Springfield, Springfield, Missouri
| | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Joseph A. Sparano
- Department of Hematology-Oncology, Mount Sinai Health System, New York, New York
| | | | - Lynne I. Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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Liu J, Hunter S, Guo D, Lin Q, Zhu J, Lee RLT, Chan SWC. Decision-making about mastectomy among Chinese women with breast cancer: a mixed-methods study protocol. BMJ Open 2022; 12:e054685. [PMID: 35443949 PMCID: PMC9021815 DOI: 10.1136/bmjopen-2021-054685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The prevalence of mastectomy in China is higher than its Western counterparts. Little is known about whether Chinese women with breast cancer have been involved in the decision-making process of mastectomy, the level of decisional conflict, their perceptions of mastectomy and the factors that influence them to undergo a mastectomy. This protocol describes a mixed-methods study that aims to provide an in-depth understanding of decision-making about mastectomy among Chinese women with breast cancer. METHODS AND ANALYSIS A three-phase, sequential explanatory mixed-methods design will be adopted. The first phase is a retrospective analysis of medical records to determine the current use of mastectomy. The second phase is a cross-sectional survey to examine women's perceptions of involvement, decisional conflict and the factors influencing them to undergo a mastectomy. The third phase is an individual interview to explore women's decision-making experiences with mastectomy. Quantitative data will be analysed using descriptive statistics, t-test, Fisher's exact test, χ2 test, analysis of variance, Pearson's correlation and logistic regression. Qualitative data will be analysed by the inductive content analysis. ETHICS AND DISSEMINATION Ethical approvals for this study have been obtained from the human research ethics committees of the University of Newcastle, Australia, Zhongshan Hospital Xiamen University, China, and the First Affiliated Hospital of Xiamen University, China. Written informed consent will be obtained from the participants. Findings of this work will be disseminated at international conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Jing Liu
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Dongmei Guo
- Department of Breast Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Radiotherapy Quality Control Center, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, People's Republic of China
- School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Regina Lai-Tong Lee
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sally Wai-Chi Chan
- President Office, Tung Wah College, Hong Kong, People's Republic of China
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Kapur H, Chen L, Warburton R, Pao JS, Dingee C, Kuusk U, Bazzarelli A, McKevitt E. De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada? Curr Oncol 2021; 29:144-154. [PMID: 35049687 PMCID: PMC8775231 DOI: 10.3390/curroncol29010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/19/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Quality Indicators (QIs), including the breast-conserving surgery (BCS) rate, were published by the European and American Breast Cancer Societies and this study assesses these in a Canadian population to look for opportunities to de-escalate surgery. A total of 2311 patients having surgery for unilateral, unifocal breast cancer between 2013 and 2017 were identified and BCS QIs calculated. Reasons for mastectomy had been prospectively collected with synoptic operative reporting. Our BCS rate for invasive cancer < 3 cm was 77.1%, invasive cancer < 2 cm was 84.1%, and DCIS < 2 cm was 84.9%. There was no statistically significant change in BCS rates over a five-year period, but there was a reduction in contralateral prophylactic mastectomies (CPM) from 28% in 2013 to 16% in 2017 (p < 0.001). Trend analysis looking at tumour size and medical need for mastectomy indicated that 80% of patients at our centre would be eligible for BCS with tumour cut off of 2.5 cm. Our institution met American but not European QI standards for BCS rates, potentially indicating a difference in patient demographics compared to Europe. Our results support the understanding that BCS rates are influenced by multiple factors and are challenging to compare across jurisdictions. CPM rates may offer a more actionable opportunity to de-escalate surgery for breast cancer.
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Affiliation(s)
- Hannah Kapur
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Leo Chen
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Urve Kuusk
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
- Correspondence:
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Obeidat RF, Masri MA, Marzouq M. Factors Affecting Jordanian Women's Surgical Treatment Decisions for Early-Stage Breast Cancer. Asia Pac J Oncol Nurs 2021; 8:711-719. [PMID: 34790855 PMCID: PMC8522584 DOI: 10.4103/apjon.apjon-20105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/26/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: This study aimed to assess factors influencing surgical treatment decisions for early-stage breast cancer among Jordanian women. Methods: A descriptive correlational survey design was utilized to meet the study objective. A total of 180 Jordanian women diagnosed with unilateral early-stage breast cancer (Stages I–II) were recruited from the radiotherapy departments and outpatient surgical and breast cancer clinics at King Hussein Cancer Center (KHCC). Participants completed a structured questionnaire consisting of the Arabic version of the Depression Anxiety Stress Scale, Breast Surgery Beliefs and Expectations Scale, and the Arabic version of the Control Preference Scale. Results: The majority of the participants underwent mastectomy as a definitive surgical treatment (i.e. 67%). Only stage at diagnosis and having a second opinion about surgical treatment options were significantly associated with the type of surgical procedure women opted for. The overwhelming majority of the participants in both groups cited the items of “Minimize the chance of breast cancer coming back” and “Minimize the chance of dying of breast cancer” as very important in their decisions for surgical treatment of unilateral early-stage breast cancer. Women who cited the item “remove breast for peace of mind” as important/very important were more likely to opt for mastectomy than women who cited the item as not important. Conclusions: Mastectomy is the preferred surgical treatment option for the majority of Jordanian women diagnosed with unilateral early-stage breast cancer at KHCC.
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Affiliation(s)
| | - Mahmoud Al Masri
- Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan
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Blackmore T, Chepulis L, Keenan R, Kidd J, Stokes T, Weller D, Emery J, Lawrenson R. How do colorectal cancer patients rate their GP: a mixed methods study. BMC FAMILY PRACTICE 2021; 22:67. [PMID: 33832431 PMCID: PMC8034162 DOI: 10.1186/s12875-021-01427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND New Zealand (NZ) has a high incidence of colorectal cancer (CRC) and low rates of early diagnosis. With screening not yet nationwide, the majority of CRC is diagnosed through general practice. A good patient-general practitioner (GP) relationship can facilitate prompt diagnosis, but when there is a breakdown in this relationship, delays can occur. Delayed diagnosis of CRC in NZ receives a disproportionally high number of complaints directed against GPs, suggesting deficits in the patient-GP connection. We aimed to investigate patient-reported confidence and ratings of their GP following the diagnostic process. METHODS This study is a mixed methods analysis of responses to a structured questionnaire and free text comments from patients newly diagnosed with CRC in the Midland region of NZ. A total of 195 patients responded to the structured questionnaire, and 113 patients provided additional free text comments. Descriptive statistics were used to describe the study population and chi square analysis determined the statistical significance of factors possibly linked to delay. Free text comments were analysed using a thematic framework. RESULTS Most participants rated their GP as 'Very good/Good' at communication with patients about their health conditions and involving them in decisions about their care, and 6.7% of participants rated their overall level of confidence and trust in their GP as 'Not at all'. Age, gender, ethnicity and a longer diagnostic interval were associated with lower confidence and trust. Free text comments were grouped in to three themes: 1. GP Interpersonal skills; (communication, listening, taking patient symptoms seriously), 2. Technical competence; (speed of referral, misdiagnoses, lack of physical examination), and 3. Organisation of general practice care; (appointment length, getting an appointment, continuity of care). CONCLUSIONS Māori, females, and younger participants were more likely to report low confidence and trust in their GP. Participants associate a poor diagnostic experience with deficits in the interpersonal and technical skills of their GP, and health system factors within general practice. Short appointment times, access to appointments and poor GP continuity are important components of how patients assess their experience and are particularly important to ensure equal access for Māori patients.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin, University of Otago, Dunedin, New Zealand
| | - David Weller
- Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jon Emery
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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Variations in breast cancer surgical treatment and timing: determinants and disparities. Breast Cancer Res Treat 2021; 188:259-272. [PMID: 33689057 PMCID: PMC8233284 DOI: 10.1007/s10549-021-06155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/20/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention. METHODS Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively. RESULTS A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (-2.96, 95% CI -4.39 to -1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities. CONCLUSIONS Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.
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Ansmann L, Schabmann A, Gross SE, Gross-Kunkel A, Albert US, Osipov I. Are There Disparities in Surgical Treatment for Breast Cancer Patients with Prior Physical Disability A Path Analysis. Breast Care (Basel) 2020; 15:400-407. [PMID: 32982651 DOI: 10.1159/000503777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/28/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Cancer care for patients with prior physical disability has hardly been researched in clinical research, health services research, or special education. This article aims to compare the severity of disease and the surgical treatment of diagnosed breast cancer patients with and without prior physical disability. Methods A total of 4,194 patients with primary breast cancer who underwent surgery in a breast cancer center in North Rhine-Westphalia, Germany, participated in an annual postoperative postal survey, which was complemented by clinical data. Latent class analysis and logit path models were applied to study (1) differences in terms of UICC staging and local cancer treatment between patients with and without prior physical disability and (2) respective differences by disability severity. Results Patients with physical disability (n = 780; 18.7%) had a higher chance of receiving mastectomy compared to breast-conserving therapy, even after controlling for socioeconomic status and UICC staging. Disability severity is directly and indirectly associated with receiving a mastectomy. Conclusion In light of the research gap on disability and cancer, this work indicates disparities in care for breast cancer patients with prior physical disability. Inequalities might be attributable to (1) unequal access to care, (2) individual preferences and difficulties, or (3) medical difficulties.
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Affiliation(s)
- Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alfred Schabmann
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Sophie Elisabeth Gross
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.,LVR Institute of Health Care Research, LVR Clinic Cologne, Cologne, Germany
| | - Anke Gross-Kunkel
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Ute-Susann Albert
- AWMF Institute for Medical Knowledge Management, Faculty of Medicine, Philipps-University, Marburg, Germany
| | - Igor Osipov
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany.,School of Education, University of Wuppertal, Wuppertal, Germany
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Casaubon JT, Kuehn RB, Pesek SE, Raker CA, Edmonson DA, Stuckey A, Gass JS. Breast-Specific Sensuality and Appearance Satisfaction: Comparison of Breast-Conserving Surgery and Nipple-Sparing Mastectomy. J Am Coll Surg 2020; 230:990-998. [PMID: 32272205 DOI: 10.1016/j.jamcollsurg.2020.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND We demonstrated previously that lumpectomy (L) patients reported higher appearance satisfaction, appreciation of a pleasurable breast caress, and persistence of the breast during intimacy than mastectomy with reconstruction, which we used to describe breast-specific sensuality. Our current objective was to compare breast-specific sensuality between L and nipple-sparing mastectomy (NSM). DESIGN An anonymous, cross-sectional survey was distributed to breast cancer survivors between 2014 and 2016. Eligible patients underwent operation between 2000 and 2014, were adults older than 18 years, English-speaking, and at least one year into the post-operative period. Demographic characteristics, treatment details, Female Sexual Function Index metrics, and investigator-generated questions about appearance satisfaction and breast-specific sensuality were collected. RESULTS Of the 600 women who participated, 585 surveys were eligible. Surgical modality was reported as L by 406 (69.4%), mastectomy alone by 50 (8.5%), and mastectomy with reconstruction by 129 (22.1%). Nipple-preservation data were available for 47 of 129 mastectomy with reconstruction patients (36.4%), with 21 NSM and 26 non-nipple-sparing mastectomy patients. Favorable postoperative appearance satisfaction was reported by 76.2% of L and 71.4% of NSM (p = 0.039). Lumpectomy patients reported feeling more comfortable being seen undressed than NSM patients (82.4% vs 71.4%; p = 0.0003). The chest remained a part of intimacy for 65.4% of L patients vs 42.9% of NSM patients (p = 0.0009). A pleasurable breast caress was reported more frequently by L patients than NSM patients (66.2% vs 20%; p ≤ 0.0001). The breast caress was unpleasant for 40% of NSM patients, nearly 4-fold higher than L patients (11.3%; p < 0.0001). CONCLUSIONS NSM patients were significantly less satisfied with appearance, less comfortable being seen undressed, had decreased persistence of breast intimacy, and experienced a less pleasurable breast caress than L patients. Counseling patients about these findings will empower informed decision making, optimize expectations, and can enhance postoperative satisfaction.
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Affiliation(s)
- Jesse T Casaubon
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
| | - Reed B Kuehn
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Sarah E Pesek
- Breast Surgery, St Peter's Health Partners, Albany, NY
| | - Christina A Raker
- Division of Research, Women & Infants Hospital of Rhode Island, Providence, RI
| | - David A Edmonson
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Ashley Stuckey
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
| | - Jennifer S Gass
- Program in Women's Oncology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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Gu J, Delisle M, Engler-Stringer R, Groot G. Mastectomy versus breast-conservation therapy: an examination of how individual, clinicopathologic, and physician factors influence decision-making. ACTA ACUST UNITED AC 2019; 26:e522-e534. [PMID: 31548821 DOI: 10.3747/co.26.5079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The choice of mastectomy compared with breast-conservation therapy (bct) in early-stage breast cancer (esbca) is a complicated decision-making process. Interprovincially, Canada's mastectomy rates vary from 25% to 68%, with Saskatchewan reporting the nation's second-highest mastectomy rate at 63%. The aim of our research was to better understand why women with esbca choose mastectomy rather than bct in Saskatchewan. Methods We created a survey based on a previously developed framework that organizes influencing factors into 3 constructs: clinicopathologic, physician, and individual belief factors. Results Treatment choice was found to be influenced by disease stage and multiple individual belief factors. Compared with their counterparts having stage i disease, women with stage ii disease were significantly more likely to undergo mastectomy [odds ratio (or): 7.48]. Patients rating "worry about cancer recurrence" and "total treatment time" as more influential in their choice were also more likely to undergo mastectomy (or: 3.4 and 1.8 respectively). Conversely, women rating "wanting to keep own breast tissue," "tumour size," and "surgeon's opinion" as influential in their choice were more likely to undergo bct (or: 0.17, 0.66, and 0.69 respectively). Conclusions Our study demonstrates that treatment choices for Saskatchewan women with esbca are influenced primarily by disease stage and individual belief factors. Those findings suggest that women are making their treatment choices predominantly based on individual values and preferences. The use of rates of mastectomy and bct as indicators of quality of care might be misleading. Instead, a shift in attention toward patient-centred care might be more appropriate.
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Affiliation(s)
- J Gu
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
| | - M Delisle
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - R Engler-Stringer
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
| | - G Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK
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Wu SG, Zhang WW, Wang J, Dong Y, Chen YX, He ZY. Effect of 21-gene recurrence score in decision-making for surgery in early stage breast cancer. Onco Targets Ther 2019; 12:2071-2078. [PMID: 30962690 PMCID: PMC6433114 DOI: 10.2147/ott.s199625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim We aimed to assess the role of 21-gene recurrence score (RS) in the decision-making for surgical treatment in early stage breast cancer and compared the outcomes between breast-conserving surgery (BCS) and mastectomy (MAST) among various 21-gene RS groups. Methods We included patients with stage T1-2M0M0 and estrogen receptor-positive breast invasive ductal carcinoma who underwent BCS + radiotherapy or MAST between 2004 and 2012 as part of the Surveillance, Epidemiology, and End Results program. Data were analyzed using binomial logistic regression, multivariate Cox proportional hazards models, and propensity score matching (PSM). Results We enrolled 34,447 patients including 22,681 (65.8%) and 11,766 (34.2%) who underwent BCS and MAST, respectively. Patients with high-risk RS were more likely to receive MAST. Multivariate analysis indicated that patients with intermediate-risk (P<0.001) and high-risk (P<0.001) RS had poor breast cancer-specific survival (BCSS), as compared to those with low-risk RS. Moreover, patients who underwent MAST also exhibited poor BCSS (P<0.001), as compared to those who underwent BCS. In low-risk (P<0.001) and intermediate-risk (P=0.020) RS groups, patients who underwent MAST had poor BCSS, as compared to those treated with BCS. However, BCSS was comparable between patients who underwent MAST and BCS (P=0.952); similar trends were also observed after PSM. Conclusion The 21-gene RS may impact the decision-making for surgery in early stage breast cancer. Our study provides additional support for a shared decision-making process for BCS when both local management options are appropriate choices regardless of the 21-gene RS.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
| | - Jun Wang
- Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Yong Dong
- Department of Oncology, Dongguan Third People's Hospital, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan 523326, People's Republic of China
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen 361005, People's Republic of China,
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China,
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Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases. Cancers (Basel) 2019; 11:cancers11020160. [PMID: 30709048 PMCID: PMC6406394 DOI: 10.3390/cancers11020160] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 12/19/2022] Open
Abstract
Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.
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Campbell I, Lao C, Blackmore T, Edwards M, Hayes L, Ng A, Lawrenson R. Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand. ANZ J Surg 2018; 88:1263-1268. [DOI: 10.1111/ans.14840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Campbell
- School of Medicine; The University of Auckland; Auckland New Zealand
- Waikato District Health Board; Hamilton New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Tania Blackmore
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Melissa Edwards
- School of Medicine; The University of Auckland; Auckland New Zealand
| | - Louise Hayes
- Waikato District Health Board; Hamilton New Zealand
| | - Alex Ng
- Department of General Surgery, Auckland City Hospital; Auckland New Zealand
| | - Ross Lawrenson
- Waikato District Health Board; Hamilton New Zealand
- Medical Research Centre, University of Waikato; Hamilton New Zealand
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Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H. Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review. Clin Breast Cancer 2018; 18:e539-e554. [DOI: 10.1016/j.clbc.2017.12.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/22/2017] [Indexed: 01/11/2023]
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Gu J, Groot G. Creation of a new clinical framework - why women choose mastectomy versus breast conserving therapy. BMC Med Res Methodol 2018; 18:77. [PMID: 29986654 PMCID: PMC6038174 DOI: 10.1186/s12874-018-0533-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Clinical medicine has lagged behind other fields in understanding and utilizing frameworks to guide research. In this article, we introduce a new framework to examine why women choose mastectomy versus breast conserving therapy in early stage breast cancer, and highlight the importance of utilizing a conceptual framework to guide clinical research. METHODS The framework we present was developed through integrating previous literature, frameworks, theories, models, and the author's past research. RESULTS We present a conceptual framework that illustrates the central domains that influence women's choice between mastectomy versus breast conserving therapy. These have been organized into three broad constructs: clinicopathological factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and individual belief factors. The aim of this framework is to provide a comprehensive basis to describe, examine, and explain the factors that influence women's choice of mastectomy versus breast conserving therapy at the individual level. CONCLUSION We have developed a framework with the purpose of helping health care workers and policy makers better understand the multitude of factors that influence a patient's choice of therapy at an individual level. We hope this framework is useful for future scholars to utilize, challenge, and build upon in their own work on decision-making in the setting of breast cancer. For clinician-researchers who have limited experience with frameworks, this paper will highlight the importance of utilizing a conceptual framework to guide future research and provide an example.
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Affiliation(s)
- Jeffrey Gu
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
| | - Gary Groot
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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