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Wanis KN, Kuerer HM, Sun SX, Hunt KK, Glencer AC, Teshome M, Lucci A, Weiser R, Johnson H, Smith BD, Gutierrez AM, Shaitelman SF, Arun BK. Clinical Outcomes for BRCA Pathogenic Variant Carriers With Breast Cancer Undergoing Breast Conservation. JAMA Netw Open 2024; 7:e2418486. [PMID: 38916888 PMCID: PMC11200147 DOI: 10.1001/jamanetworkopen.2024.18486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/19/2024] [Indexed: 06/26/2024] Open
Abstract
Importance Although most women with BRCA-associated breast cancer choose bilateral mastectomy, current guidelines support breast-conserving therapy as an option. As the indications for genetic testing expand and targeted therapies emerge, understanding the outcomes of breast-conserving therapy in the population of patients choosing breast conservation is important. Objective To describe the clinical outcomes of women with BRCA-associated breast cancer who were treated with breast-conserving therapy, including the risks of ipsilateral and contralateral cancer events and bilateral mastectomy-free survival. Design, Setting, and Participants This cohort study conducted at a single-institution academic national comprehensive cancer center included 172 women identified from a prospectively maintained database who had pathogenic BRCA1/2 variants and were treated with breast-conserving therapy from January 1, 1977, to December 31, 2021. Main Outcomes and Measures Clinical and pathologic characteristics for patients with BRCA1 and BRCA2 were compared, and estimates of overall survival, bilateral mastectomy-free survival, distant disease-free survival, risk of ipsilateral breast cancer, and risk of contralateral cancer were computed. Results The cohort included 172 women (mean [SD] age, 47.1 [11.7] years), with 42 (24.4%) receiving a diagnosis of breast cancer prior to 40 years of age. Compared with BRCA2 variant carriers (80 [46.5%]), women with BRCA1 variants (92 [53.5%]) were younger at breast cancer diagnosis and tended to have more advanced tumors, which were more likely to be hormone receptor negative and higher grade. At a median follow-up of 11.8 years (IQR, 5.7-18.2 years), estimates of 10-year survival and risk were: overall survival, 88.5% (95% CI, 83.1%-94.2%); bilateral mastectomy-free survival, 70.7% (95% CI, 63.3%-78.9%); risk of an ipsilateral breast cancer event, 12.2% (95% CI, 5.8%-18.2%); and risk of contralateral cancer, 21.3% (95% CI, 13.3%-28.6%). Risks continued to increase after 10 years of follow-up. Conclusions and Relevance In this cohort study, although women with breast cancer and pathogenic BRCA1/2 variants treated with breast-conserving therapy had above-average risks of ipsilateral and contralateral breast cancer events, most did not have another cancer event and remained bilateral mastectomy free. These findings may be useful for informing patients with BRCA variants choosing breast conservation.
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Affiliation(s)
| | - Henry M. Kuerer
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Susie X. Sun
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Alexa C. Glencer
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Mediget Teshome
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Anthony Lucci
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Roi Weiser
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Helen Johnson
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D. Smith
- Department of Breast Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Simona F. Shaitelman
- Department of Breast Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Banu K. Arun
- Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, Texas
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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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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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Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Immediate breast reconstruction uptake in older women with primary breast cancer: systematic review. Br J Surg 2022; 109:1063-1072. [PMID: 35909248 PMCID: PMC10364779 DOI: 10.1093/bjs/znac251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Postmastectomy immediate breast reconstruction (PMIBR) may improve the quality of life of patients with breast cancer, of whom older women (aged 65 years or more) are a growing proportion. This study aimed to assess PMIBR in older women with regard to underlying impediments (if any). METHODS MEDLINE, Embase, and PubMed were searched by two independent researchers up to June 2022. Eligible studies compared PMIBR rates between younger and older women with invasive primary breast cancer. RESULTS A total of 10 studies (2012-2020) including 466 134 women were appraised, of whom two-thirds (313 298) were younger and one-third (152 836) older. Only 10.0 per cent of older women underwent PMIBR in contrast to 45.0 per cent of younger women. Two studies explored factors affecting uptake of PMIBR in older women; surgeon-associated (usual practice), patient-associated (socioeconomic status, ethnicity, and co-morbidities), and system-associated (insurance status and hospital location) factors were identified. CONCLUSION Uptake of PMIBR in older women is low with definable (and some correctable) barriers.
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Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria Joao Cardoso
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Breast Unit, Champalimaud Foundation and Nova Medical School Lisbon, Lisbon, Portugal
| | - Kwok Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Correspondence to: Ruth M. Parks, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK (e-mail: )
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Lee RXN, Yogeswaran G, Wilson E, Oni G. Barriers and facilitators to breast reconstruction in ethnic minority women-A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:463-474. [PMID: 33309318 DOI: 10.1016/j.bjps.2020.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women. METHODS The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies. RESULTS Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status). CONCLUSION Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women. REGISTRATION Prospero ID: CRD42019133233.
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Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
| | - Gowsika Yogeswaran
- University of Nottingham, School of Medicine, Nottingham, United Kingdom
| | - Emma Wilson
- University of Nottingham, School of Medicine, Nottingham, United Kingdom
| | - Georgette Oni
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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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: 16] [Impact Index Per Article: 2.7] [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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Zhang L, Gao J, Lin D, Xie L, Wang T, Zou L. Personal factors influencing breast cancer patients' perception of breast conservation surgery in West China. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:313. [PMID: 31475183 DOI: 10.21037/atm.2019.06.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Breast cancer patients' understanding of therapies is a very important factor during their surgical treatment decision-making. To date, there has been no report in this area about Chinese patients. Aiming to evaluate the perception of breast conservation surgery (BCS) in Chinese breast cancer patients (CBCP) and explore influencing factors. Methods A self-structured questionnaire was distributed to 1,496 CBCPs, eliciting information on patients' age, religion, sexual history, occupation, education, whether they were pre- or postoperative, understanding of BCS and their means of gaining information. Results A total of 1,324 (88.5%) patients completed the questionnaire. Only 2.42% of patients had more understanding of BCS. Patients' perception about BCS was associated with their age, religion, occupation, education background and whether they were postoperative or not (P<0.01). Surgeon was the most commonly way being used to obtain information (68.9%); however, this was not significant in affecting patients' perception [odds ratios (OR) =1.034; 95% confidence intervals (CI): 0.762-1.402]. Patients using books and/or internet to obtain information on BCS had better understanding (OR =1.665; 95% CI: 1.249-2.193), but only 20.2% patients used this way to search for information. Conclusions The study indicated that CBCP' perception of BCS was poor, they lacked access to information. Therefore, educating patients and making them master knowledge about BCS were a hard work in China.
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Affiliation(s)
- Li Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China.,Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jidong Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Dongcai Lin
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Li Xie
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Tianyu Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China.,State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610017, China
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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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Veerman MM, van der Woude LA, Tellier MA, Legemaate J, Scheltinga MR, Stassen LPS, Leclercq WKG. A decade of litigation regarding surgical informed consent in the Netherlands. PATIENT EDUCATION AND COUNSELING 2019; 102:340-345. [PMID: 30173877 DOI: 10.1016/j.pec.2018.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE An inadequate surgical informed consent process (SIC) may result in a medical malpractice claim or medical disciplinary board (MDB) complaint. Aim of this study was to analyse characteristics of a decade of malpractice claims and MDB decisions regarding SIC in the Netherlands. METHODS A retrospective analysis of malpractice claims and MDB decisions concerning SIC disputes in four major surgical specialties was conducted based on company data from the largest medical malpractice insurance company and two public available online MDB databases. RESULTS A total of 11376 malpractice claims and 661 MDB complaints were filed between 2004-2013 and 676(6%) of these claims and 69(10%) of these complaints involved an alleged deficient SIC process. A random sample of 245(37%) claims and all MDB decisions were analysed. Reasons for filing a claim or complaint were insufficient counselling or recording of SIC elements. In 20% of lawsuits and 25% of claims the case resulted in favour of the complainant. CONCLUSION A substantial portion of malpractice claims and MDB decisions is related to a deficient SIC process. PRACTICE IMPLICATIONS Focusing on crucial SIC elements for patients may improve satisfaction and expectations and result in a lower risk for malpractice claims and MDB complaints.
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Affiliation(s)
- M M Veerman
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - L A van der Woude
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - M A Tellier
- Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands
| | - J Legemaate
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - M R Scheltinga
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands
| | - L P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W K G Leclercq
- Department of Plastic Surgery, Rivierenland Hospital, Tiel, The Netherlands; Department of Plastic Surgery, Isala klinieken, Zwolle, The Netherlands; Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Surgery, Máxima Medisch Centrum, Eindhoven - Veldhoven, The Netherlands.
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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: 10.1] [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: 0.7] [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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12
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Sattaratnamai A, Samankatiwat N, Lohsiriwat V. Surgeons’ Recommendation is the Factor in Determining the Breast Cancer Surgery Procedures: an Experience from Rural
Hospital in Thailand. Asian Pac J Cancer Prev 2018; 19:1189-1193. [PMID: 29801400 PMCID: PMC6031837 DOI: 10.22034/apjcp.2018.19.5.1189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: The majority of breast cancer patients in rural hospital in developing countries still warrant for total mastectomy. Surgeon advice regard surgical procedure is one of the most important factors in decision making. Our study aims to compare the rate of breast-conserving surgery (BCS), mastectomy (MT) and mastectomy with immediate breast reconstruction (MTIBR) between the surgeons who offer only MT (group A) and who offer BCS MT and MTIBR (group B). Method: A retrospective cohort study was conducted at Ratchaburi hospital, Thailand from January 2010 to April 2014. We categorized patients into 2 groups (group A and B). Univariated analysis was selected to determine the factors that associated with the breast surgery procedures. Results: From January 2010 to April 2014, we recruited 310 breast cancer patients, 221 patients (71.2%) were treated by surgeons in group A, 89 patients (28.7%) by surgeons in group B. The choice of breast surgery is significantly different between 2 groups (P<0.001). In group A, 213 (96.3%) patient had MT and only 3 (1.3%) BCS and 5 (2.2%) MTIBR. Whilst in group B, 58 (65.1%) patient had MT and 11 (12.3%) BCS and 20(22.4%) MTIBR. Choice of breast surgery in patients with stage 1,2,3 are significantly different between 2 groups (P=0.004, <0.001, 0.025 respectively). Age is the only factor that significantly affects the choice of surgery in the group B but not in group A. Conclusion: Surgeon’s competency and comprehensive preoperative consultation by offering BCS, MT and MTIBR can affect the choice of surgical procedure for breast cancer patient.
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13
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Tucholka JL, Jacobson N, Steffens NM, Schumacher JR, Tevaarwerk AJ, Anderson B, Wilke LG, Greenberg CC, Neuman HB. Breast cancer survivor's perspectives on the role different providers play in follow-up care. Support Care Cancer 2018; 26:2015-2022. [PMID: 29332175 DOI: 10.1007/s00520-018-4042-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/03/2018] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Significant variation in the number and types of oncologists that provide breast cancer follow-up exists. However, there is limited understanding regarding breast cancer survivors' preferences for who provides their follow-up. Our objective was to explore breast cancer survivors' perspectives on the goals of breast cancer follow-up, the preferred role for primary care providers, and the perceived roles of different types of oncologists during follow-up. METHODS A convenience sample of stage 0-III breast cancer survivors was identified and in-depth one-on-one interviews conducted. Data were analyzed using inductive content analysis. RESULTS Survivors cited a strong preference for oncology-based follow-up within the first 5 years after diagnosis, driven by their need for reassurance that cancer had not recurred. Survivors also thought that their primary care provider needed to be involved. Survivors assumed that oncology follow-up was directed by a standard protocol that included streamlining the follow-up team. Survivors recognized that patients with more complex cancers or challenging treatment courses may require more intensive follow-up and deviate from the standard protocol. Most survivors were comfortable deferring decisions regarding who participated in follow-up to the oncology team. CONCLUSIONS Most patients think a streamlined approach to oncology-based breast cancer follow-up already occurs, driven by a standard protocol. The use of a standard protocol to provide guidance for which types of oncology providers should participate in breast cancer follow-up will streamline care and represents a significant opportunity to reduce unnecessary variation. This approach is especially critical given patients' strong preferences for oncology-based follow-up.
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Affiliation(s)
- J L Tucholka
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - N Jacobson
- School of Nursing, Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - N M Steffens
- Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA
| | - J R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - A J Tevaarwerk
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA.,Department of Medicine, Division of Hematology and Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - B Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - L G Wilke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA
| | - C C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, H4/726 CSC, 600 Highland Ave., Madison, WI, 53792-7375, USA.
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14
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Su S, Bao H, Wang X, Wang Z, Li X, Zhang M, Wang J, Jiang H, Wang W, Qu S, Liu M. The quality of invasive breast cancer care for low reimbursement rate patients: A retrospective study. PLoS One 2017; 12:e0184866. [PMID: 28910357 PMCID: PMC5599036 DOI: 10.1371/journal.pone.0184866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/03/2017] [Indexed: 01/02/2023] Open
Abstract
Though evidence-based treatments have been recommended for breast cancer, underuse of the treatments was still observed. To certain extent, patients' access to care, which can be enhanced by increasing the coverage of health insurance, could account for the current underuse in recommended care. This study aimed to examine the association between different proportions of reimbursement and quality of recommended breast cancer care, as well as length of hospital stay. In this retrospective study, 3669 patients diagnosed with invasive breast cancer between 1 June, 2011 and 30 June, 2013 were recruited. Seven quality indicators from preoperative diagnosis procedures to adjuvant therapy and one composite indicator were selected as dependent variables. Logistic regression and generalized linear models were used to explore the association between quality of care and length of hospital stay with different reimbursement rates. Compared with UEBMI (urban employment basic medical insurance), which represented high level reimbursement rate, patients with lower rates of reimbursement were less likely to receive core biopsy, HER-2 (human epidermal growth factor receptor-2) testing, BCS (breast conserving surgery), SLNB (sentinel lymph nodes biopsy), adjuvant therapy and hormonal treatment. No significant difference in preoperative length of hospital stay was observed among the three insurance schemes, however URBMI (urban resident basic medical insurance) insured patients stayed longer for total length of hospital stay. Significant disparities in utilization of evidence-based breast cancer care among patients with different proportions of reimbursement were observed. Patients with lower rate of reimbursement were less likely to receive recommended care. Our findings could provide important support for further healthcare reform and quality improvement in breast cancer care.
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Affiliation(s)
- Shaofei Su
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Han Bao
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Xinyu Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Zhiqiang Wang
- School of Medicine, University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Xi Li
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meiqi Zhang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Jiaying Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Hao Jiang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Wenji Wang
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Siyang Qu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
| | - Meina Liu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China
- * E-mail:
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15
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Moghaddam Tabrizi F, Alizadeh S, Barjasteh S. Managerial Self-Efficacy for Chemotherapy-Related Symptoms and Related Risk Factors in Women with Breast Cancer. Asian Pac J Cancer Prev 2017; 18:1549-1553. [PMID: 28669166 PMCID: PMC6373813 DOI: 10.22034/apjcp.2017.18.6.1549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Breast cancer is one of the most important diseases affecting physical, psychological and social health
of women. This study aimed to determine managerial self-efficacy regarding chemotherapy-related symptoms and
related risk factors in Iranian patients. Materials and methods: This descriptive-analytical cross-sectional study was
conducted on 150 patients with breast cancer referred to medical centers of Urmia in 2016 with a convenience sampling
method . The data collection instrument was the symptom-management self-efficacy scale-breast cancer (SMSES-BC)
questionnaire whose validity and reliability was evaluated for the first time for Iranians. Data were analyzed using SPSS
software version 20. Results: Most of the patients were in the age range of 41-49 years. Lowest scores were in the areas
of emotional and interpersonal disorders and the highest scores in the area of managing chemotherapy-related symptoms.
The mean score of self-efficacy chemotherapy-related symptoms was 168.0±25.4. There were significant relationships
between age, education, economic status, marital status and life status and self-efficacy chemotherapy-related symptoms.
In addition, a positive significant correlation for each of the subscales. Conclusion: It should be noted that interventional
efforts for improving managerial self-efficacy of symptoms, especially management of interpersonal and emotional
disorders in these patients are necessary.
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Affiliation(s)
- Fatemeh Moghaddam Tabrizi
- Reproductive Health Research Center, Nursing and Midwifery Department, Urmia University
of Medical Sciences, Urmia, Iran.
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16
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Gass JS, Onstad M, Pesek S, Rojas K, Fogarty S, Stuckey A, Raker C, Dizon DS. Breast-Specific Sensuality and Sexual Function in Cancer Survivorship: Does Surgical Modality Matter? Ann Surg Oncol 2017; 24:3133-3140. [DOI: 10.1245/s10434-017-5905-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/18/2022]
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17
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Gu J, Groot G, Holtslander L, Engler-Stringer R. Understanding Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early-Stage Breast Cancer. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2017; 11:1179554917691266. [PMID: 28469511 PMCID: PMC5395266 DOI: 10.1177/1179554917691266] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify factors that influence Saskatchewan women's choice between breast conserving therapy (BCT) and mastectomy in early-stage breast cancer (ESBC) and to compare and contrast underlying reasons behind choice of BCT versus mastectomy. METHODS Interpretive description methods guided this practice-based qualitative study. Data were analyzed using thematic analysis and presented in thematic maps. RESULTS Women who chose mastectomy described 1 of the 3 main themes: worry about cancer recurrence, perceived consequences of BCT treatment, or breast-tumor size perception. In contrast, women chose BCT because of 3 different themes: mastectomy being too radical, surgeon influence, and feminine identity. CONCLUSIONS Although individual reasons for choosing mastectomy versus BCT have been discussed in the literature before, different rationale underlying each choice has not been previously described. These results are novel in identifying interdependent subthemes and secondary reasons for each choice. This is important for increased understanding of factors influencing a complicated decision-making process.
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Affiliation(s)
- Jeffrey Gu
- Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lorraine Holtslander
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Engler-Stringer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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18
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Bellavance E, Peppercorn J, Kronsberg S, Greenup R, Keune J, Lynch J, Collyar D, Magder L, Tilburt J, Hlubocky F, Yao K. Surgeons' Perspectives of Contralateral Prophylactic Mastectomy. Ann Surg Oncol 2016; 23:2779-87. [PMID: 27169770 DOI: 10.1245/s10434-016-5253-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contralateral prophylactic mastectomy (CPM) is commonly performed for the treatment of breast cancer, despite its limited oncologic benefit. Little is known about surgeons' perceptions of performing CPM. We hypothesized that a proportion of surgeons would report discomfort with performing CPM, particularly when there is discordance between patients' perceived benefit from CPM and the expected oncologic benefit. METHODS A survey was sent to members of the American Society of Breast Surgeons seeking self-reports of surgeons' practice patterns, perceptions, and comfort levels with CPM. RESULTS Of the 2436 members surveyed, 601 responded (response rate = 24.7 %). The median age of respondents was 52 years, and 59 % of responders were women. The majority (58 %) reported that 80 % of their practice was devoted to the treatment of breast disease. Fifty-seven percent (n = 326) of respondents reported discomfort with performing CPM at some point in their practice. While most surgeons (95 %) were comfortable with CPM on a patient with a deleterious BRCA mutation, only 34 % were comfortable performing CPM on an average-risk patient. The most common reasons reported for surgeon discomfort with CPM were a concern for overtreatment, an unfavorable risk/benefit ratio, and inadequate patient understanding of the anticipated risks and benefits of CPM. CONCLUSIONS Despite the increasing use of CPM for the treatment of breast cancer, many surgeons report discomfort with CPM. Concerns with performing CPM predominantly focus on ambiguities surrounding the oncologic benefit and relative risk of this procedure. Further research is needed to define optimal shared decision-making practices in this area.
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Affiliation(s)
- Emily Bellavance
- Department of Surgery, University of Maryland, Baltimore, MD, USA.
| | - Jeffrey Peppercorn
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Shari Kronsberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Rachel Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jason Keune
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Julie Lynch
- Veterans Health Administration, Bedford, MA, USA.,RTI International, Research Triangle Park, NC, USA
| | | | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Jon Tilburt
- Division of General Internal Medicine and Biomedical Ethics Research Unit and Knowledge & Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Fay Hlubocky
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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19
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Recio-Saucedo A, Gerty S, Foster C, Eccles D, Cutress RI. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. Breast 2015; 25:1-13. [PMID: 26801410 DOI: 10.1016/j.breast.2015.11.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/28/2015] [Accepted: 11/01/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. METHODS Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. RESULTS Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. CONCLUSION Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients.
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Affiliation(s)
| | - Sue Gerty
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - Claire Foster
- University of Southampton, Faculty of Health Sciences, Southampton SO17 1BJ, UK
| | - Diana Eccles
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK
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20
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Onitilo AA, Engel JM, Stankowski RV, Doi SAR. Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy. Clin Med Res 2015; 13:65-73. [PMID: 25487237 PMCID: PMC4504664 DOI: 10.3121/cmr.2014.1245] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/14/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Evidence suggests superiority of breast conserving surgery (BCS) plus radiation over mastectomy alone for treatment of early stage breast cancer. Whether the superiority of BCS plus radiation is related to the surgical approach itself or to the addition of adjuvant radiation therapy following BCS remains unclear. MATERIALS AND METHODS We conducted a retrospective cohort study of women with breast cancer diagnosed from 1994-2012. Data regarding patient and tumor characteristics and treatment specifics were captured electronically. Kaplan-Meier survival analyses were performed with inverse probability of treatment weighting to reduce selection bias effects in surgical assignment. RESULTS Data from 5335 women were included, of which two-thirds had BCS and one-third had mastectomy. Surgical decision trends changed over time with more women undergoing mastectomy in recent years. Women who underwent BCS versus mastectomy differed significantly regarding age, cancer stage/grade, adjuvant radiation, chemotherapy, and endocrine treatment. Overall survival was similar for BCS and mastectomy. When BCS plus radiation was compared to mastectomy alone, 3-, 5-, and 10-year overall survival was 96.5% vs 93.4%, 92.9% vs 88.3% and 80.9% vs 67.2%, respectively. CONCLUSION These analyses suggest that survival benefit is not related only to the surgery itself, but that the prognostic advantage of BCS plus radiation over mastectomy may also be related to the addition of adjuvant radiation therapy. This conclusion requires prospective confirmation in randomized trials.
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Affiliation(s)
- Adedayo A Onitilo
- Department of Hematology/Oncology, Marshfield Clinic-Weston Center, Weston, Wisconsin, USA School of Population Health, University of Queensland, Brisbane, Australia
| | - Jessica M Engel
- Department of Hematology/Oncology, Marshfield Clinic Cancer Care, Stevens Point, Wisconsin, USA
| | | | - Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Australia
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21
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Ashraf B, Tasnim N, Saaiq M, Zaman KU. An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC). Int J Health Policy Manag 2014; 3:315-321. [PMID: 25396207 PMCID: PMC4226621 DOI: 10.15171/ijhpm.2014.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/26/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. METHODS This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. RESULTS Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. CONCLUSION The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.
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Affiliation(s)
- Bushra Ashraf
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Nasira Tasnim
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Muhammad Saaiq
- Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Khaleeq-Uz- Zaman
- Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
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22
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Giraud P, Malinvaud D, Ménard M, Consoli S, Bonfils P, Laccourreye O. [Which choice would the radiation oncologist consider if facing an advanced stage laryngeal cancer?]. Cancer Radiother 2014; 18:649-54. [PMID: 25304064 DOI: 10.1016/j.canrad.2014.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/08/2014] [Accepted: 05/20/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyse the therapeutic decision considered by radiation oncologists put in a position of being diagnosed with an advanced stage cancer of the larynx accessible either to a total laryngectomy or to an organ preservation protocol. MATERIALS AND METHODS Prospective analysis based on an anonymous survey filled by 104 radiation oncologists. RESULTS A total of 30.7% of radiation oncologists surveyed did not consider any trade in their cure rate to preserve their larynx. The median percentage of cure that they were willing to trade was 10% (2-100%); and 0.9% of them were willing to trade 100% of their chance for cure in order to "avoid" total laryngectomy. A total of 16.3% of radiation oncologists would like to receive more information before making their decision. The additional information most frequently requested concerned the precise stage of the tumour and the potential remedial treatment in case of failure of the laryngeal preservation protocol. None of the analysed demographic variables influenced the choice to trade or not survival chance to preserve the larynx, the percentage of chance that radiation oncologists would consider exchanging, and/or the wish to receive additional information. CONCLUSION This prospective study highlights that larynx preservation protocol is not the main therapeutic goal shared by all radiation oncologists put in a position of being diagnosed with an advanced stage cancer of the larynx. Total laryngectomy should remain a treatment option that as organ preservation protocols to be proposed and discussed.
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Affiliation(s)
- P Giraud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France.
| | - D Malinvaud
- Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France; Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France; Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - S Consoli
- Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France; Service de psychiatrie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Bonfils
- Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France; Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Université Paris Descartes, Paris Cité Sorbonne, 75015 Paris, France; Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Ristevski E, Regan M, Birks D, Steers N, Byrne A. A qualitative study of rural women's views for the treatment of early breast cancer. Health Expect 2014; 18:2928-40. [PMID: 25267503 DOI: 10.1111/hex.12277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
AIM Identify what factors rural women perceived to influence their surgical choice for EBC. BACKGROUND Higher rates of mastectomy still remain for women with early breast cancer (EBC) in rural areas. While access to radiotherapy is a commonly identified barrier, there is growing debate around other factors which are also important influences on surgical choice. METHODS Qualitative study with 70 interviews with women diagnosed with EBC in rural Gippsland, Australia. Twenty-nine women had a mastectomy and 41 had breast conserving surgery (BCS). RESULTS Patient led psychosocial and surgeon led factors influenced surgical choice. Psychosocial factors were a greater influence for the mastectomy group. These included a high fear of cancer recurrence and radiotherapy, negative views of the body and breast, a family history of cancer, wanting to avoid the negative treatment experiences they had seen significant others go through, and not wanting to travel for treatment. Surgeon led factors were a greater influence for the BCS group, in particular, the direct recommendation made by the surgeon for BCS. For both groups, urgency to act was a shared psychosocial factor. Trust and confidence in the expertise and reputation of the surgeon and their consultation style were surgeon led factors shared by the groups. CONCLUSIONS To ensure women achieve the best treatment outcome, patients and clinicians need to work together to identify how important and influential the various factors are for the women and, if necessary, to seek support to ensure informed decisions are made.
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Affiliation(s)
- Eli Ristevski
- Monash University, School of Rural Health - Monash University Department of Rural and Indigenous Health, Moe, Victoria, Australia
| | - Melanie Regan
- Monash University, School of Rural Health - Monash University Department of Rural and Indigenous Health, Moe, Victoria, Australia
| | - David Birks
- Monash University, School of Rural Health - Churchill, Churchill, Victoria, Australia
| | - Nicole Steers
- Latrobe Community Health Service, Morwell, Victoria, Australia
| | - Anny Byrne
- West Gippsland HealthCare Group, Warragul, Victoria, Australia
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Laccourreye O, Malinvaud D, Ménard M, Consoli S, Giraud P, Bonfils P. Otorhinolaryngologists' personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:339-343. [PMID: 24993784 DOI: 10.1016/j.anorl.2014.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol. MATERIAL AND METHODS Prospective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables. RESULTS A total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P=0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P=0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P=0.03) and their age (P=0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information. CONCLUSION Treatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.
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Affiliation(s)
- O Laccourreye
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - D Malinvaud
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Consoli
- Service de psychiatrie, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - P Bonfils
- Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, université Paris Descartes Sorbonne Paris Cité, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Bollet MA, Kirova YM, Fourquet A, de Cremoux P, Reyal F. Prognostic factors for local recurrence following breast-conserving treatment in young women. Expert Rev Anticancer Ther 2014; 10:1215-27. [DOI: 10.1586/era.10.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Onitilo AA, Onesti JK, Single RM, Engel JM, James TA, Aiello Bowles EJ, Feigelson HS, Barney T, McCahill LE. Utilization of neoadjuvant chemotherapy varies in the treatment of women with invasive breast cancer. PLoS One 2013; 8:e84535. [PMID: 24376822 PMCID: PMC3869842 DOI: 10.1371/journal.pone.0084535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Treatment with neoadjuvant chemotherapy (NAC) has made it possible for some women to be successfully treated with breast conservation therapy (BCT ) who were initially considered ineligible. Factors related to current practice patterns of NAC use are important to understand particularly as the surgical treatment of invasive breast cancer has changed. The goal of this study was to determine variations in neoadjuvant chemotherapy use in a large multi-center national database of patients with breast cancer. METHODS We evaluated NAC use in patients with initially operable invasive breast cancer and potential impact on breast conservation rates. Records of 2871 women ages 18-years and older diagnosed with 2907 invasive breast cancers from January 2003 to December 2008 at four institutions across the United States were examined using the Breast Cancer Surgical Outcomes (BRCASO) database. Main outcome measures included NAC use and association with pre-operatively identified clinical factors, surgical approach (partial mastectomy [PM] or total mastectomy [TM]), and BCT failure (initial PM followed by subsequent TM). RESULTS Overall, NAC utilization was 3.8%l. Factors associated with NAC use included younger age, pre-operatively known positive nodal status, and increasing clinical tumor size. NAC use and BCT failure rates increased with clinical tumor size, and there was significant variation in NAC use across institutions. Initial TM frequency approached initial PM frequency for tumors >30-40 mm; BCT failure rate was 22.7% for tumors >40 mm. Only 2.7% of patients undergoing initial PM and 7.2% undergoing initial TM received NAC. CONCLUSIONS NAC use in this study was infrequent and varied among institutions. Infrequent NAC use in patients suggests that NAC may be underutilized in eligible patients desiring breast conservation.
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Affiliation(s)
- Adedayo A. Onitilo
- Department of Hematology and Oncology, Marshfield Clinic, Weston, Wisconsin, USA and Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, Australia
- * E-mail:
| | - Jill K. Onesti
- Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA
| | - Richard M. Single
- University of Vermont, Burlington, Vermont, United States of America
| | - Jessica M. Engel
- Marshfield Clinic Cancer Care at St Michaels Hospital, Stevens Point, Wisconsin, United States of America
| | - Ted A. James
- University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | | | | | - Tom Barney
- Van Andel Research Institute, Grand Rapids, Michigan, United States of America
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Feigelson HS, James TA, Single RM, Onitilo AA, Aiello Bowles EJ, Barney T, Bakerman JE, McCahill LE. Factors associated with the frequency of initial total mastectomy: results of a multi-institutional study. J Am Coll Surg 2013; 216:966-75. [PMID: 23490543 DOI: 10.1016/j.jamcollsurg.2013.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/11/2013] [Accepted: 01/16/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not entirely clear. Using a multi-institution database, we analyzed how practice, patient, and tumor characteristics contributed to variation in TM for invasive breast cancer. STUDY DESIGN We collected detailed clinical and pathologic data about breast cancer diagnosis, initial, and subsequent breast cancer operations performed on all female patients from 4 participating institutions from 2003 to 2008. We limited this analysis to 2,384 incident cases of invasive breast cancer, stages I to III, and excluded patients with clinical indications for mastectomy. Predictors of initial TM were identified with univariate analyses and random effects multivariable logistic regression models. RESULTS Initial TM was performed on 397 (16.7%) eligible patients. Use of preoperative MRI more than doubled the rate of TM (odds ratio [OR] = 2.44; 95% CI, 1.58-3.77; p < 0.0001). Increasing tumor size, high nuclear grade, and age were also associated with increased rates of initial TM. Differences by age and ethnicity were observed, and significant variation in the frequency of TM was seen at the individual surgeon level (p < 0.001). Our results were similar when restricted to tumors <20 mm. CONCLUSIONS We identified factors associated with initial TM, including preoperative MRI and individual surgeon, that contribute to the current debate about variation in use of TM for the management of breast cancer. Additional evaluation of patient understanding of surgical options and outcomes in breast cancer and the impact of the surgeon provider is warranted.
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Smith SM, Balise RR, Norton C, Chen MM, Flesher AN, Guardino AE. A feasibility study to evaluate breast cancer patients' knowledge of their diagnosis and treatment. PATIENT EDUCATION AND COUNSELING 2012; 89:321-9. [PMID: 23031612 PMCID: PMC5310250 DOI: 10.1016/j.pec.2012.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/09/2012] [Accepted: 08/25/2012] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the feasibility of an electronic survey to assess patients' knowledge of their breast cancer and treatment, and interest in receiving a medical summary. METHODS Women undergoing breast cancer treatment completed an interviewer-administered electronic survey in person or by telephone. Medical records were abstracted to evaluate knowledge accuracy. RESULTS Among 38 eligible patients approached for the study, 35 (92%) participated and 33 (94%) completed the survey. Participants' perceived knowledge tended to be greater than their actual knowledge. Reporting of clinicopathologic features was most accurate for stage (91%) and lymph node status (88%), and least accurate for tumor size (61%), type (61%), and grade (33%). Accurate reporting of tumor receptor over-expression varied from 76% (estrogen receptor) to 39% (progesterone receptor). Many patients correctly recalled general treatment modalities and details of surgery; fewer recalled details of radiation and chemotherapy. Importantly, nearly all (32/33) were interested in receiving a breast cancer medical summary. CONCLUSION An electronic survey is feasible to assess breast cancer patients' knowledge. This data suggest that patients have gaps in knowledge and would like a personalized medical summary. PRACTICE IMPLICATIONS Larger studies are needed to validate and characterize knowledge gaps, and test interventions to improve physician-patient information sharing.
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Affiliation(s)
- Stephanie M Smith
- Stanford University School of Medicine, Stanford University, Stanford, CA 94305, USA.
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Sepucha KR, Belkora JK, Chang Y, Cosenza C, Levin CA, Moy B, Partridge A, Lee CN. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak 2012; 12:51. [PMID: 22681763 PMCID: PMC3411423 DOI: 10.1186/1472-6947-12-51] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 05/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals. METHODS Cross-sectional mail survey of recent breast cancer survivors, providers and healthy controls and a retest survey of survivors. The decision quality instrument includes knowledge questions and a set of goals, and results in two scores: a breast cancer surgery knowledge score and a concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, discriminant validity, content validity, predictive validity and retest reliability of the survey instrument were examined. RESULTS We had responses from 440 eligible patients, 88 providers and 35 healthy controls. The decision quality instrument was feasible to implement in this study, with low missing data. The knowledge score had good retest reliability (intraclass correlation coefficient=0.70) and discriminated between providers and patients (mean difference 35%, p<0.001). The majority of providers felt that the knowledge items covered content that was essential for the decision. Five of the 6 treatment goals met targets for content validity. The five goals had moderate to strong retest reliability (0.64 to 0.87). The concordance score was 89%, indicating that a majority had treatments concordant with that predicted by their goals. Patients who had concordant treatment had similar levels of confidence and regret as those who did not. CONCLUSIONS The decision quality instrument met the criteria of feasibility, reliability, discriminant and content validity in this sample. Additional research to examine performance of the instrument in prospective studies and more diverse populations is needed.
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Affiliation(s)
- Karen R Sepucha
- General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey K Belkora
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Yuchiao Chang
- General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts, 100 Morrissey Boulevard, Boston, MA, USA
| | - Carrie A Levin
- Informed Medical Decision Foundation, 40 Court Street, Boston, MA, USA
| | - Beverly Moy
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, USA
| | - Ann Partridge
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, MA, USA
| | - Clara N Lee
- Division of Plastic and Reconstructive Surgery, Lineberger Comprehensive Cancer Center, Sheps Center for Health Services Research, University of North Carolina, CB Box 7195, Chapel Hill, NC, 27599-7195, USA
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Sivell S, Marsh W, Edwards A, Manstead ASR, Clements A, Elwyn G, BresDex group. Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. PATIENT EDUCATION AND COUNSELING 2012; 86:179-88. [PMID: 21571485 DOI: 10.1016/j.pec.2011.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 03/07/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. METHODS An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. RESULTS BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). CONCLUSION This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. PRACTICE IMPLICATIONS BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team.
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Affiliation(s)
- Stephanie Sivell
- Marie Curie Palliative Care Research Group, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
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Collaborators
Lisa Caldon, Karen Collins, T J Day, Rhodri Evans, Julietta Patnick, Malcolm W R Reed, Veronica Rogers,
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Servant N, Bollet MA, Halfwerk H, Bleakley K, Kreike B, Jacob L, Sie D, Kerkhoven RM, Hupé P, Hadhri R, Fourquet A, Bartelink H, Barillot E, Sigal-Zafrani B, van de Vijver MJ. Search for a Gene Expression Signature of Breast Cancer Local Recurrence in Young Women. Clin Cancer Res 2012; 18:1704-15. [DOI: 10.1158/1078-0432.ccr-11-1954] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ristevski E, Regan M, Birks D, Steers N, Byrne A, McGrail MR. Communicating about breast cancer: rural women's experience of interacting with their surgeon. Aust J Rural Health 2012; 20:22-8. [PMID: 22250873 DOI: 10.1111/j.1440-1584.2011.01245.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines. DESIGN The study was designed as a cross-sectional survey. SETTING The study was set in Eastern regional Victoria, Australia. PARTICIPANTS Seventy women diagnosed with early breast cancer participated in the study. MAIN OUTCOME MEASURES The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision-making; and (iii) preparing the woman for specific management. RESULTS No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision-making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment. CONCLUSION Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.
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Affiliation(s)
- Eli Ristevski
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Victoria, Australia.
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Sexual Health During Cancer Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:61-76. [DOI: 10.1007/978-94-007-2492-1_5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. PATIENT EDUCATION AND COUNSELING 2012; 86:9-18. [PMID: 21474265 PMCID: PMC4530615 DOI: 10.1016/j.pec.2011.02.004] [Citation(s) in RCA: 567] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population. METHODS Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure. RESULTS 115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported. CONCLUSION Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population. PRACTICE IMPLICATIONS The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.
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Affiliation(s)
- Betty Chewning
- Sonderegger Research Center, University of Wisconsin School of Pharmacy, Madison, WI 53705-2222, USA.
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Swainston K, Campbell C, van Wersch A, Durning P. Treatment decision making in breast cancer: a longitudinal exploration of women's experiences. Br J Health Psychol 2011; 17:155-70. [PMID: 22233108 DOI: 10.1111/j.2044-8287.2011.02028.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the lived experience of breast cancer in relation to the treatment decision-making process over time. DESIGN Adopting a hermeneutic phenomenological approach, semi-structured interviews were undertaken at three points in time during the year following diagnosis. METHODS After ethical approval had been obtained, 20 women who were recently diagnosed with breast cancer were recruited from a Symptomatic Breast Cancer Unit in the North East of England. RESULTS Four themes emerged: role in the treatment decision-making process; acceptance of medical opinions; getting rid of it; and cancer schemas. The majority of women reported a passive role in the surgical treatment decision-making process and all women did so in relation to subsequent treatment decisions. However, women adopted this role consciously and consequently were not disengaged from the process but maintained a sense of ownership and control over their health. The women did not describe experiencing decisional regret at any point in the year following diagnosis and rarely revisited the decisions made, only doing so in a positive manner. Trust in the abilities and experience of healthcare professionals and maximizing chances of survival were cited as reasons for not having had greater involvement. Despite being given information about treatment options, many women made the decision not to attend to this information perceiving this to be anxiety provoking. CONCLUSIONS The findings from this study suggest a need for eliciting more specific psycho-social interactions in the treatment decision-making process in order to identify ways in which women can be supported throughout their experience.
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Sivell S, Edwards A, Elwyn G, Manstead ASR. Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions? Health Expect 2011; 14 Suppl 1:6-19. [PMID: 20579123 PMCID: PMC5057170 DOI: 10.1111/j.1369-7625.2009.00558.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). BACKGROUND A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. DESIGN Literature search and narrative synthesis of data. SYNTHESIS Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. CONCLUSIONS The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.
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Affiliation(s)
- Stephanie Sivell
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK.
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Zhang L, Jiang M, Zhou Y, Du XB, Yao WX, Yan X, Jiang Y, Zou LQ. Survey on breast cancer patients in China toward breast-conserving surgery. Psychooncology 2011; 21:488-95. [DOI: 10.1002/pon.1922] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 12/26/2010] [Accepted: 12/27/2010] [Indexed: 11/05/2022]
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Keating NL, Landrum MB, Brooks JM, Chrischilles EA, Winer EP, Wright K, Volya R. Outcomes following local therapy for early-stage breast cancer in non-trial populations. Breast Cancer Res Treat 2011; 125:803-13. [PMID: 20376555 PMCID: PMC2924956 DOI: 10.1007/s10549-010-0865-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/19/2010] [Indexed: 12/26/2022]
Abstract
Recent studies suggest trends toward more mastectomies for primary breast cancer treatment. We assessed survival after mastectomy and breast-conserving surgery (BCS) with radiation for early-stage breast cancer among non-selected populations of women and among women similar to those in clinical trials. Using population-based data from Surveillance Epidemiology, and End Results cancer registries linked with Medicare administrative data from 1992 to 2005, we conducted propensity score analysis of survival following primary therapy for early-stage breast cancer, including BCS with radiation, BCS without radiation, mastectomy with radiation, and mastectomy without radiation. Adjusted survival was greatest among women who had BCS with radiation (median survival = 10.98 years). Compared with this group, mortality was higher among women who had mastectomy without radiation (median survival 10.04 years, adjusted hazard ratio (HR) = 1.19, 95% confidence interval (CI) = 1.14-1.23), mastectomy with radiation (median survival 10.02 years, HR = 1.20, 95% CI = 1.14-1.27), and BCS without radiation (median survival 7.63 years, HR = 1.81, 95% CI = 1.70-1.92). Among women representative of those eligible for clinical trials (age ≤70 years, Charlson comorbidity score = 0/1, and stage 1 tumors), there were no differences in survival for women who underwent BCS with radiation or mastectomy. In conclusion, after careful adjustment for differences in patient, physician, and hospital characteristics, we found better survival for BCS with radiation versus mastectomy among older early-stage breast cancer patients, with no difference in survival for BCS with radiation versus mastectomy among women representative of those in clinical trials. These findings are reassuring in light of recent trends towards more aggressive primary breast cancer therapy.
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Affiliation(s)
- Nancy L Keating
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
As most solid tumors, surgery is often the first step of the multidisciplinary management for breast cancers. Although mastectomy and axillar lymphadenectomy still have indications, conservative treatment and sentinel node detection are commonly used. Thanks to induction chemotherapy and oncoplastic techniques, surgery is conservative in most cases, even for important tumors without overall survival prejudice. There is no consensus about resection margins status but a limit of 2 to 3 mm seems to be reasonable while oncoplastic surgery allows large resection and good cosmetic outcomes. In this overview, we present the state of the art for breast cancer surgery including conservative and radical treatments, axillar lymphadenectomy and sentinel lymph node detection, margins status, oncoplastic techniques.
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Measuring the influence of colleagues on a consultant team's use of breast conserving surgery. Int J Technol Assess Health Care 2010; 26:156-62. [PMID: 20392318 DOI: 10.1017/s0266462310000061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to examine potential reasons why the use of breast conserving surgery (BCS) for breast cancer varies substantially between hospital teams in England, and in particular to examine whether colleague influence has a role in influencing BCS rates locally. METHODS Routinely collected Hospital Episode Statistics (HES) data relating to 420 surgical teams in England who performed more than ten breast cancer operations during the financial year 2006/07 were used to identify predictors of team BCS use. Team BCS rates (as a proportion of all types of breast excision surgery) were subject to a regression analysis that incorporated, as independent variables, a range of patient, organizational, and local demographic factors, as well as the BCS rate of colleagues working alongside them in the same hospitals(s). RESULTS After adjusting for the effects of other variables, BCS use by colleagues working in the same hospital(s) was a significant predictor of a team's own BCS rate (standardized b = 0.224; p < .001), denoting a typical 3 percent increase in a team's BCS rate for every 10 percent increase in the BCS rate of colleagues. CONCLUSIONS The practice of colleagues seems to have a measurable influence upon a surgical team's BCS usage. Guidance from HTA organizations can set national standards about the use of new techniques and innovations, but dissemination can be either slowed down or accelerated by the influence of local colleagues. A strategy of disseminating guidance through professional networks or "local champions" could be a powerful avenue for change.
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Sepucha K, Ozanne EM. How to define and measure concordance between patients' preferences and medical treatments: A systematic review of approaches and recommendations for standardization. PATIENT EDUCATION AND COUNSELING 2010; 78:12-23. [PMID: 19570647 DOI: 10.1016/j.pec.2009.05.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 04/03/2009] [Accepted: 05/23/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose is to systematically review the methods used to calculate the association between patients' preferences and treatment choices and to present a set of recommendations for definition and measurement of this concept. METHODS A systematic review of the literature from 1967 to 2007 identified articles that reported a relationship between patients' preferences and their treatment choices. Potential citations were identified from electronic databases, the Cochrane Collaborative review, and identified experts. Relevant articles were abstracted by two reviewers independently using standard forms. RESULTS The search identified 3114 unique citations, the full text of 180 articles was examined, and 49 articles were included. These 49 studies used a variety of definitions of preferences and choices, and calculated concordance in different ways. Half of the studies tied their method to a theoretical framework. There were problems with many of the studies that limit the ability to generalize or make comparisons across studies. CONCLUSION There is no consistent method for defining or calculating the match between patients' preferences and treatment choices. There is a need for more clarity in the definition and reporting of this type of concordance in measures of decision quality. PRACTICE IMPLICATIONS The match between an informed patient's preferences and treatment choices is a key component of patient-centered care. Valid and reliable measures of the level of concordance are needed.
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Affiliation(s)
- Karen Sepucha
- Health Decision Research Unit, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), 50 Staniford Street, Suite 936, Boston, MA 02114, USA
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Bollet MA, Savignoni A, De Koning L, Tran-Perennou C, Barbaroux C, Degeorges A, Sigal-Zafrani B, Almouzni G, Cottu P, Salmon R, Servant N, Fourquet A, de Cremoux P. Tumor aromatase expression as a prognostic factor for local control in young breast cancer patients after breast-conserving treatment. Breast Cancer Res 2009; 11:R54. [PMID: 19638208 PMCID: PMC2750115 DOI: 10.1186/bcr2343] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Revised: 06/18/2009] [Accepted: 07/28/2009] [Indexed: 02/08/2023] Open
Abstract
Introduction We sought to determine whether the levels of expression of 17 candidate genes were associated with locoregional control after breast-conserving treatments of early-stage breast cancers in young, premenopausal women. Methods Gene expression was measured by using RT-PCR in the breast tumors of a series of 53 young (younger than 40 years), premenopausal patients. All treatments consisted of primary breast-conserving surgery followed by whole-breast radiotherapy (± regional lymph nodes) with or without systemic treatments (chemotherapy ± hormone therapy). The median follow-up was 10 years. Results The 10-year locoregional control rate was 70% (95% CI, 57% to 87%). In univariate analysis, no clinical/pathologic prognostic factors were found to be significantly associated with decreased locoregional control. Expression of three genes was found to be significantly associated with an increased locoregional recurrence rate: low estrogen-receptor β, low aromatase, and high GATA3. Two others were associated with only a trend (P < 0.10): low HER1 and SKP2. In multivariate analysis, only the absence of aromatase was significantly associated with an increased locoregional recurrence rate (P = 0.003; relative risk = 0.49; 95% CI 0.29 to 0.82). Conclusions Recent data give credit to the fact that breast cancer in young women is a distinct biologic entity driven by special oncogenic pathways. Our results highlight the role of estrogen-signaling pathways (mainly CYP19/aromatase, GATA3, and ER-β) in the risk of locoregional recurrence of breast cancer in young women. Confirmation in larger prospective studies is needed.
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Affiliation(s)
- Marc A Bollet
- Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75248 Paris, France.
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Liu J, Hao XS, Yu Y, Fang ZY, Liu JT, Niu Y, Fentiman IS. Long-Term Results of Breast Conservation in Chinese Women with Breast Cancer. Breast J 2009; 15:296-8. [DOI: 10.1111/j.1524-4741.2009.00720.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen JH, Feig BA, Hsiang DJB, Butler JA, Mehta RS, Bahri S, Nalcioglu O, Su MY. Impact of MRI-evaluated neoadjuvant chemotherapy response on change of surgical recommendation in breast cancer. Ann Surg 2009; 249:448-54. [PMID: 19247033 PMCID: PMC2789298 DOI: 10.1097/sla.0b013e31819a6e01] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate how MRI imaging of neoadjuvant chemotherapy (NAC) tumor response affects the recommendation for optimal breast cancer surgery, both before and after NAC. SUMMARY BACKGROUND DATA Understanding how imaging findings are incorporated into surgeons' decision-making processes will help establish appropriate imaging guidelines for recommending breast conservation surgery (BCS) after the NAC. METHODS Seventy-six breast cancer patients undergoing NAC with MRI follow-up studies were analyzed. Two experienced breast surgeons reviewed all cases. An initial surgical recommendation was made based on the pre-NAC lesion presentation; a subsequent surgical recommendation was made based on the post-NAC tumor response. Finally, the pathology results were disclosed and the surgeons were asked to decide on the optimal definitive surgical procedure. MRI findings throughout the entire course of the NAC were analyzed to understand how they affected different recommendations. RESULTS Before the NAC, a large tumor size or extent of disease were the primary determinant factors for mastectomy. In this study, the mean tumor size was 5.3 +/- 3.4 cm (RECIST) in the mastectomy group and 3.2 +/- 1.6 cm in the lumpectomy group (P = 0.0001). After the NAC, based on consensus recommendations, 21 mastectomy candidates remained for mastectomy, with tumor size decreasing from 7.4 +/- 4.5 to 1.5 +/- 2.5 cm, and 22 mastectomy candidates were changed to lumpectomy, with tumor size decreasing from 4.2 +/- 2.1 to 0.4 +/- 0.6 cm. When the final pathology revealed pCR or minimal residual disease, the surgeons agreed that BCS is the optimal procedure. On the other hand, for a large extent of residual disease, mastectomy should be performed. CONCLUSION In patients who had more extensive pretreatment disease, despite an excellent response to NAC, the surgeons still tended to apply an aggressive approach and recommended mastectomy. Given that the confirmation of pCR or minimal residual disease would change surgeons' recommendations for less aggressive, conservation surgery, the maturity of MRI for NAC response prediction may provide reliable staging information to aid in the recommendation of the optimal surgical procedure.
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Affiliation(s)
- Jeon-Hor Chen
- Tu and Yuen Center for Functional Onco-Imaging, University of California, Irvine, California 92697-5020, USA
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Ballinger RS, Mayer KF, Lawrence G, Fallowfield L. Patients’ decision-making in a UK specialist centre with high mastectomy rates. Breast 2008; 17:574-9. [DOI: 10.1016/j.breast.2008.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 08/01/2008] [Indexed: 11/15/2022] Open
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Phillips KA, Osborne RH, Giles GG, Dite GS, Apicella C, Hopper JL, Milne RL. Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol 2008; 26:4666-71. [PMID: 18824713 DOI: 10.1200/jco.2007.14.8718] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results. PATIENTS AND METHODS A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors. RESULTS Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008). CONCLUSION The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.
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Affiliation(s)
- Kelly-Anne Phillips
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Carlton, Victoria 3053, Australia
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Affiliation(s)
- Peter G Cordeiro
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Keulers BJ, Scheltinga MRM, Houterman S, Van Der Wilt GJ, Spauwen PHM. Surgeons underestimate their patients' desire for preoperative information. World J Surg 2008; 32:964-70. [PMID: 18408963 PMCID: PMC2386849 DOI: 10.1007/s00268-008-9581-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Provision of adequate patient information may contribute to a “satisfying” surgical treatment. The patient’s views on successful transfer of information concerning operative characteristics may not be in concert with the surgeon’s. The aim of the present study was to determine opinions of both surgeons and patients about issues of surgical information. Methods A group of surgeons (n = 24) and surgical patients (n = 125) responded to a questionnaire that included 80 topics involving domains of information on disease, physical examination, preoperative period, anesthesia, operation, postoperative period, self care, and general hospital issues. Both groups were asked for their opinion on what they considered important and useful preoperative information for patients. Questions were scored with a visual analog scale. The reliability of the questionnaire was calculated with Cronbach’s alpha. Differences in opinions between surgeons and patients were analyzed with Student’s t-test. Results The Cronbach’s alpha of the questionnaire was high (0.91), indicating its high reliability. Patients scored significantly higher (p < 0.001) in most domains, including preoperative period, anaesthesia, operation, postoperative period, self care, and general hospital information. Women demonstrated a significantly higher need for information than men did. These findings were independent of patient age or complexity of operation. In contrast, surgeons thought that their patients desired more extensive information on cause, effect, and prognosis of the disease itself (p < 0.001). Conclusion Surgeons generally underestimate their patients’ desire for receiving extensive information prior to a surgical procedure of any complexity. Surgeons should develop strategies to bridge this informational mismatch.
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Affiliation(s)
- B J Keulers
- Máxima Medical Centre (MMC), Veldhoven, The Netherlands.
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