Early Postoperative Outcomes of Breast Cancer Surgery in a Developing Country

Knowledge, Attitudes, and Practices of Chinese Breast Cancer Patients Towards Comprehensive Postoperative Self-Management: a Cross-Sectional Study

Purpose

To comprehensively assess the knowledge, attitudes, and practices (KAP) of Chinese breast cancer (BC) patients regarding postoperative self-management (POSM) and identify factors influencing self-management behaviors.

Methods

Questionnaire surveys were administered to BC patients who underwent surgery. A total of 566 participants (98.94% female), mainly from rural areas (65.55%) and married (97.53%), were included. Knowledge was measured using 10 questions (score range: 0-20), attitude with 6 questions (score range: 6-30), and practice with 7 questions (score range: 6-30). Scores were categorized as inadequate (0%-39.99%), moderate (40%-70%), or satisfactory (>70% of maximum score). Demographic data were collected, and statistical analyses, including T-tests, ANOVA, non-parametric tests, and Spearman correlation, were used for comparisons and associations.

Results

The average knowledge score was 20.00 (100% of the maximum score), with correct answer rates ranging from 92.58% to 99.29%. Attitude scores averaged 29.00 (96.66% of maximum), with 95.93-98.76% of participants showing positive or very positive attitudes. The average practice score was 26.00 (86.66% of maximum), with notable gaps in seeking psychological support (28.27% negative responses) and lifestyle adjustments (41.34% negative responses). Pearson correlation analysis revealed positive associations between knowledge and attitude (r = 0.227, p < 0.001), and attitude and practice (r = 0.111, p = 0.008). Multivariable analysis found homemakers showed better practices compared to employed individuals (OR = 9.667, 95% CI = 2.483-37.643, p = 0.001), while those with "other" employment status had lower odds of practice (OR = 0.437, 95% CI = 0.206-0.927, p = 0.031). Patients with Stage II or III tumors had lower odds of practice compared to Stage I tumors (OR = 0.273, 95% CI = 0.110-0.677, p = 0.005; OR = 0.157, 95% CI = 0.060-0.410, p < 0.001, respectively).

Conclusion

This study highlights the importance of addressing gaps between knowledge, attitudes, and practices in BC patients undergoing postoperative recovery. Tailored interventions focusing on specific barriers identified in practice behaviors, such as seeking psychological support and lifestyle adjustments, are crucial to enhance overall postoperative care and improve health outcomes for BC patients.

Mechanism of the effect of Piper crocatum extract on wound healing of Wistar rats post-excision mammary tumor based on IL-10 level, TGF-β1 expression, VEGF expression, Collagen density, and clinical features

Background

The incidence of wound complications after breast cancer surgery is > 30%. Delayed wound healing increases the risk of systemic recurrence up to three-fold after excisional surgery for primary breast cancer. Patients with breast malignant tumors exhibit immune system dysfunction while T cells play a major role in the inflammatory process of wound healing. The time required to achieve wound closure depends on the severity of the wound. The content of Piper crocatum ethanol extract contains alkaloids, flavonoids, tannins, steroids, and polyphenols. Flavonoid and polyphenol compounds are antioxidant, antidiabetic, anticancer, antiseptic, and anti-inflammatory.

Aim

To determine whether P. crocatum extract increases interleukin-10 (IL-10) levels, TGF-β1 and VEGF expression, collagen density, and the clinical features of wounds, and how the mechanism works on wound healing of Wistar rats after excision of mammary tumors.

Methods

This study used 35 female Wistar rats, 30 mammary tumor models by injecting 3-5% benzopyrene as much as 50 mg/Kg.BW in 5 injections into the mammary glands/mammae every 2 days as much as 10 mg/kg.BW. Thirty rats were divided into 5 groups; red betel extract gel 50%, 25%, and 12.5%; povidone iodine group as a positive control; and carboxymethyl cellulose natrium (CMC na) group as a negative control, 5 normal wounds as controls. Treatment was given 2 times a day for 14 days.

Results

Multiple linear regression results; P. crocatum extract decreased IL-10 levels by -0.64 (p = 0.025), decreased TGF-β1 expression -0.832 (p = 0.001), increased VEGF expression by 0.638 (p = 0.026), and decreased collagen density by -0.605 (p = 0.037) in mammary tumor post-excision rat wounds.

Conclusion

There is an effect of P. crocatum extract on the wound of Wistar rats after excision of mammary tumor by the mechanism of decreased IL-10 levels and TGF-β1 expression, increased VEGF expression, and decreased collagen density through increased VEGF expression is studied in this article.

Information Needs Among Thai Women Breast Cancer Patients During the Initial Treatment Phase: A Cross-Sectional Study

AIMS

To examine the information needs of breast cancer patients during the initial phase of treatment and to analyse the factors that influenced these needs.

BACKGROUND

Providing comprehensive and timely information during early breast cancer treatment is crucial for informed decision-making and effective coping. Healthcare providers must address these needs to enhance patient support and improve outcomes.

DESIGN

A cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

METHODS

A total of 123 post-mastectomy patients were selected through purposive sampling and completed the Thai version of the Sri Lankan Information Needs Assessment Questionnaire-BC (SINAQ-BC). Direct associations between demographic data and information needs were analysed descriptively, while bivariate analysis and linear regression were used to identify significant predictors of information needs.

RESULTS

The findings revealed that patients exhibited high overall information needs (224.7/260.0), with the greatest demand focused on physical care, treatment and diagnosis. In contrast, needs related to disease specifics and psychosocial care were less prominent. A total of 94 respondents (76.4%) expressed a particularly high demand for information regarding physical care. Education level was identified as an influencing factor, accounting for 7.7% of the variance in information needs among women with breast cancer.

CONCLUSIONS

Patients with higher education levels had significantly greater information needs. Nursing staff should provide customised information packages that are tailored to the participants' education levels. Further testing of the Thai version of the SLINQ-BC would also be warranted.

IMPLICATIONS FOR PATIENT CARE

Patients are increasingly expected to manage their own care even as medical treatment grows more complex and technical. Nursing staff can contribute to the care of patients by being ready to evaluate, monitor and address breast cancer patient's individual information needs in the early stage of treatment based on factors such as educational level.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution because the nature of the study's design, data analysis and writing did not require patient or public contribution.

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients

PURPOSE

The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status.

METHODS

Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural-urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression.

FINDINGS

Results demonstrated that patients in small rural/isolated areas with low (B = -4.10, SE = 1.93, OR = 0.02, p = 0.03) to average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) food insecurity and average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) to high (B = -10.62, SE = 4.71, OR = 0.00, p = 0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B = 4.47, SE = 0.49, d = 0.42, p < 0.001) diabetes and low mortality (B = 5.70, SE = 0.58, d = 0.45, p < 0.001) rates have significantly more severe postmastectomy complications.

CONCLUSION

These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.

Global cancer surgery in low-resource settings: A strengths, weaknesses, opportunities, and threats analysis

Global cancer surgery is an essential and complex component of oncologic care. This study aims to describe global cancer surgery literature since the 2015 Lancet Commission on Global Surgery and Cancer Surgery and perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis. A systematic search was performed in PubMed of global cancer surgery articles. Themes were extracted from the included studies based on the following criteria: (1) performed in low- or low-middle-income countries, (2) published during or after 2015, (3) published in peer-reviewed journals, (4) written in the English language, and (5) accessible to the authors. Themes were further grouped into strengths, weaknesses, opportunities, and threats (SWOT analysis). The search strategy identified 154 articles published from 1992 to 2022. Forty-six articles were included in the qualitative synthesis and SWOT analysis. Recurring themes included local epidemiologic studies, local innovations and feasibility studies, prioritizing quality of life outcomes, multidisciplinary team approaches, limited resources, health system gaps, lack of economic analyses, diverse cancer management strategies and priorities, inter-setting collaboration, research expansion, the coronavirus disease 2019 pandemic, and unchecked technological advancements. These strengths, weaknesses, opportunities, and threats were described and related to the themes of research, surgical systems strengthening, economics and financing, and political framing of the 2015 Lancet Commission on Global Cancer Surgery. SWOT analyses of global cancer surgery may be helpful in suggesting future strategies for this expanding field. PLAIN LANGUAGE SUMMARY: Cancer surgery is a resource-intensive yet essential component of cancer care. In the face of projected growth of cancer burden, the present gap in cancer surgery care in low-resource settings with stressed health care and surgical infrastructure risks further exacerbation. We present a strengths, weaknesses, opportunities, and threats analysis of recent global cancer surgery literature pertaining to low-resource settings.

Clinicopathological Features and Survival Outcomes of Metaplastic Breast Carcinoma – An Observational Multi-Centric Study

Purpose

To describe the clinicopathological features, and subtypes of metaplastic breast cancer (MpBC) in Pakistan and further to understand its response to treatment, including region-specific survival outcomes.

Patients and Methods

This retrospective cohort study was conducted at two private tertiary care hospitals in Karachi, Pakistan. Our selection criteria included a total of 215 patients who were diagnosed with MpBC at an age older than 18 years from 1994 to 2021. Data regarding clinicopathological features, staging, receptor status, treatment modalities, recurrence, and survival was obtained. Death was scored as an event, and patients who were alive were censored at the time of the last follow-up.

Results

The incidence of MpBC at our study centers is 3.21%. The median age of diagnosis was 50 years (range 22 to 80 years) and most patients presented at Stages II (45.1%) and III (44.2%). Among patients who received neoadjuvant chemotherapy, 31.7% achieved complete pathological response. The 3-year survival of those who received neoadjuvant chemotherapy was 96%. During our study, 19.1% of patients died and the median survival duration was 9 years 7 months 9 days. Survival of patients was significantly lower in patients who had metastasis (p-value = 0.042) and those who had tumor recurrence (p-value = 0.001).

Conclusion

Metaplastic breast cancer is an extremely rare variant of breast cancer with features that exist as a spectrum. Our study demonstrated considerable success with the use of neoadjuvant chemotherapy. The pathological complete response achieved in our study is one of the highest ever reported. Our success, though limited, warrants further research in the use of neoadjuvant chemotherapy in MpBC.

Impact of modern personalized treatment of breast cancer on surgical attitude and outcomes

Multimodal treatment of breast cancer has made steady progress in recent years. The involvement of modern oncology, diagnostic imaging techniques and surgical treatment, have brought a definite benefit to patients, defining the multidisciplinary treatment of breast cancer. The introduction of immunohistochemical testing and genetic screening has led to the prioritization of therapy according to their results and a correct approach to initiating treatment. The main aim of the present study was to conduct a comparative analysis through a retrospective study of the therapeutic means used in breast cancer with the statistical evaluation of the obtained results. To carry out the study, a group of 125 patients hospitalized during the period January 2015 to December 2020, were included, and the parameters were selected from the observation sheets. The results of the study demonstrated the superiority of multimodal treatment of breast cancer over surgical treatment as the only therapeutic management. The introduction of ultrasound-guided biopsies and conservative surgical options has led to increased diagnostic accuracy and a significant improvement in aesthetic outcome. The multidisciplinary approach to breast cancer allows an individualized treatment by performing immunohistochemical testing and through the use of neoadjuvant and adjuvant treatment combined with conservative surgical techniques with a more favorable cosmetic and oncological result, with reduced postoperative complications.

Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study

BACKGROUND

Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries.

METHODS

This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent.

RESULTS

A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30-49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5-8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2-14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1-5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3-3.9)). No in-hospital mortality occurred during the course of the study.

CONCLUSION

Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.