Living with cancer and other chronic conditions: Patients' perceptions of their healthcare experience

Multimorbidity is known to contribute to the complexity of care for patients with cancer. This qualitative study begins to explore cancer patients' experience with multimodal treatments, that is, treatments for multiple chronic conditions, as well as issues related to navigating the healthcare system. Participants (n=10) were recruited from an ambulatory cancer centre in a large, university-affiliated hospital in Montreal, Quebec. Important challenges were reported in terms of striking a fine balance between acute health needs and underlying ongoing chronic condition(s), experiencing unforeseen treatment complications, and negotiating silos across medical specialties. Participants also wished to be better known by the healthcare team. When reporting a positive care coordination experience, participants often attributed it to the intervention by a nurse navigator. Lastly, participants expected a more personalized care approach and would have liked to be included in multidisciplinary board meetings. Study results underscore the impetus to better integrate care across diseases, enhance person-centred care, and support patients who strive to balance competing needs when facing multimorbidity.

Epidemiology of breast carcinoma IV: age and histologic tumor type

The purpose of this study was to correlate major chronologic events known to have a bearing on the risk for developing breast carcinoma with histologic tumor type. Data were obtained for 1024 consecutively treated patients with the seven most common forms of mammary carcinoma. The age of occurrence of the following events was determined: menarche; first marriage; first pregnancy and first childbirth; last pregnancy and last childhood; diagnosis. The interval between each of these events and diagnosis of breast cancer was also calculated. Patients with medullary carcinoma had a significantly lower mean age at diagnosis than those with any of the other tumor types. Because of the lower mean age at diagnosis, medullary carcinoma patients were found to have significantly shorter intervals between age at diagnosis and the following: menarche, first pregnancy or first childbirth, and last pregnancy or last childbirth. Intervals between age at diagnosis and these other events were not significantly different among patients with other types of carcinoma. The ages of menarche, marriage, or pregnancy were not related independently to any tumor type. These data indicate that except for current age, the age of occurrence of major risk factors for developing breast cancer is unrelated to the histological type of tumor a patient develops.

Estrogen and progesterone receptors in breast carcinoma: correlations with epidemiology and pathology

Analysis of estrogen receptor protein (ERP) was carried out on 784 patients with primary breast carcinomas. Significant relationships were found with the following epidemiologic features; age at diagnosis, menstrual status, race, and use of exogenous hormones (contraceptive and menopausal estrogens). Patients taking either type of hormone at diagnosis had lower median total ERP binding levels. Although the data do not explain how recent hormone usage affects tumor ERP, it seems advisable to discontinue these hormones as early as possible before a breast biopsy because they may cause spuriously low ERP levels. Correlation with pathology variables confirmed most prior observations relating to tumor type, histologic grade, and lymphocytic infiltrate. However, in this large series, infiltrating lobular carcinomas were not ERP-positive more frequently than duct carcinomas to any significant degree. The pattern of progesterone receptors (PRP) did not vary significantly with menstrual status, but in other respects correlations of epidemiologic and pathologic variables were similar for ERP and PRP.

Epidemiology of breast carcinoma II: factors related to the predominance of left-sided disease

A study of the laterality of 980 patients with unilateral breast carcinoma revealed a left/right ratio of 1.26. Detailed analysis disclosed a significant association between left predominance and the following clinicopathologic features: menarch after age 13, age at diagnosis, parity especially among those between ages 40 and 54, and all histologic types except medullary tumors. When asynchronous bilateral carcinoma was documented, the disease first occurred more often in the left breast. Patients with simultaneous bilateral disease usually had a larger tumor on the left. Because differences in breast size were considered a contributing factor, relative breast volumes were computed from the mammograms of 174 healthy women; 55% were found to have a larger left breast. These data and other observations cited in the literature suggest that the asymmetry of breast carcinoma reflects differences in the sensitivity of the mammary glands to hormonal stimulation, resulting in unequal volumes of tissue at risk to develop carcinoma.

Epidemiology of breast carcinoma II: factors related to the predominance of left-sided disease

A study of the laterality of 980 patients with unilateral breast carcinoma revealed a left/right ratio of 1.26. Detailed analysis disclosed a significant association between left predominance and the following clinicopathologic features: menarch after age 13, age at diagnosis, parity especially among those between ages 40 and 54, and all histologic types except medullary tumors. When asynchronous bilateral carcinoma was documented, the disease first occurred more often in the left breast. Patients with simultaneous bilateral disease usually had a larger tumor on the left. Because differences in breast size were considered a contributing factor, relative breast volumes were computed from the mammograms of 174 healthy women; 55% were found to have a larger left breast. These data and other observations cited in the literature suggest that the asymmetry of breast carcinoma reflects differences in the sensitivity of the mammary glands to hormonal stimulation, resulting in unequal volumes of tissue at risk to develop carcinoma.