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Huang X, Xu A, Xu X, Luo Z, Li C, Wang X, Fu D. Development and Validation of a Prognostic Nomogram for Breast Cancer Patients With Multi-Organ Metastases: An Analysis of the Surveillance, Epidemiology, and End Results Program Database. Am Surg 2024:31348241250044. [PMID: 38712351 DOI: 10.1177/00031348241250044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Multi-organ metastases represent a substantial life-threatening risk for breast cancer (BC) patients. Nonetheless, the current dearth of assessment tools for patients with multi-organ metastatic BC adversely impacts their evaluation. METHODS We conducted a retrospective analysis of BC patients with multi-organ metastases using data from the SEER database from 2010 to 2019. The patients were randomly allocated into a training cohort and a validation cohort in a 7:3 ratio. Univariate COX regression analysis, the LASSO, and multivariate Cox regression analyses were performed to identify independent prognostic factors in the training set. Based on these factors, a nomogram was constructed to estimate overall survival (OS) probability for BC patients with multi-organ metastases. The performance of the nomogram was evaluated using C-indexes, ROC curves, calibration curves, decision curve analysis (DCA) curves, and the risk classification system for validation. RESULTS A total of 3626 BC patients with multi-organ metastases were included in the study, with 2538 patients in the training cohort and 1088 patients in the validation cohort. Age, grade, metastasis location, surgery, chemotherapy, and subtype were identified as significant independent prognostic factors for OS in BC patients with multi-organ metastases. A nomogram for predicting 1-year, 3-year, and 5-year OS was constructed. The evaluation metrics, including C-indexes, ROC curves, calibration curves, and DCA curves, demonstrated the excellent predictive performance of the nomogram. Additionally, the risk grouping system effectively stratified BC patients with multi-organ metastases into distinct prognostic categories. CONCLUSION The developed nomogram showed high accuracy in predicting the survival probability of BC patients with multi-organ metastases, providing valuable information for patient counseling and treatment decision making.
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Affiliation(s)
- Xiao Huang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - An Xu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiangnan Xu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhou Luo
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Chunlian Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xueying Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Deyuan Fu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
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Calip GS, Hoskins KF, Guadamuz JS. Examining the Associations Among Treatment Declination, Racial and Ethnic Inequities, and Breast Cancer Survival. JAMA Netw Open 2024; 7:e249402. [PMID: 38722634 DOI: 10.1001/jamanetworkopen.2024.9402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Affiliation(s)
- Gregory S Calip
- Program on Medicines and Public Health, University of Southern California, Los Angeles
| | - Kent F Hoskins
- Division of Hematology and Oncology, University of Illinois Chicago, Chicago, Illinois
| | - Jenny S Guadamuz
- Division of Health Policy and Management, University of California, Berkeley
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3
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. Mastectomy patterns among older women with early invasive breast cancer in England and Wales: A population-based cohort study. J Geriatr Oncol 2023; 14:101653. [PMID: 37918190 DOI: 10.1016/j.jgo.2023.101653] [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: 06/16/2023] [Revised: 07/29/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Older women with early invasive breast cancer (EIBC) are more likely to receive a mastectomy compared with younger women. This study assessed factors associated with receiving a mastectomy among older women with EIBC, with a particular focus on comorbidity and frailty. MATERIALS AND METHODS Women diagnosed with EIBC (stages I-IIIa) aged ≥50 years from 2014 to 2019 in English and Welsh NHS organisations who received breast surgery were identified from cancer registration datasets linked to routine hospital data. Separate multivariable logistic regression models explored factors associated with mastectomy use, within each tumour stage (T1-T3). For each tumour stage, risk-adjusted rates of mastectomy were calculated for each NHS organisation and displayed using funnel plots. RESULTS We included 106,952 women with EIBC: 23.4% received a mastectomy as their first breast cancer surgery. Receipt of mastectomy was more common among patients with a higher tumour stage (T1: 12.3%; T2: 37.6%; T3: 77.5%), and mastectomy use increased with age within each tumour stage category (50-59 vs 80 + years: 11.8% vs 26.3% for T1; 31.5% vs 56.9% for T2; 73.4% vs 90.3% for T3). Results from a multivariable regression model showed that more severe frailty was associated with mastectomy use for women with T1 (p = 0.002) or T2 (p = 0.003) tumours, but may not be for women with T3 tumours (p = 0.041). There was no association between comorbidity and mastectomy use after accounting for frailty (all p > 0.1). Adjusting for clinical and patient factors only slightly reduced the association between age and mastectomy use. Variation in mastectomy use between NHS organisations was greatest for women with T2 EIBC (unadjusted range: 17.7% to 68.4%). DISCUSSION Older women with EIBC are more commonly treated with mastectomy. This could not be explained by tumour characteristics or physical fitness, raising questions about whether surgical decision-making inconsistently incorporates information on patient fitness and functional age.
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Affiliation(s)
- Katie Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, NHS England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Min Hae Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Quddus R, Banks J, Morgan JL, Martin C, Reed MW, Walters S, Cheung KL, Todd A, Audisio R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Parmeshwar R, Thompson A, Wyld L. Outcomes of complex oncoplastic breast surgery in older women. Analysis of data from the Age Gap cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107075. [PMID: 37774649 DOI: 10.1016/j.ejso.2023.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
KEY WORDS Breast cancer, mastectomy, breast conserving surgery, post-mastectomy reconstruction, older women, quality of life.
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Affiliation(s)
- Ratul Quddus
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jessica Banks
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | | | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool, L7 8 XP, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Alastair Thompson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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De-escalation in DCIS Care. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Facilitating and Inhibiting Factors in Deciding to Start Retreatment in Survivors of Breast Cancer Recurrence. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-132709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: Cancer recurrence is an important care challenge for breast cancer survivors. It is necessary to understand and identify the barriers and facilitators that affect the decision to start retreatment by those facing breast cancer recurrence compared to factors affecting their decision to start the initial treatment, which is different. Objectives: This study is part of a qualitative study with a grounded theory approach, which was conducted to explain the facilitating and inhibiting factors affecting the decision to start retreatment in survivors of breast cancer recurrence, using a qualitative content analysis method. Methods: This study was conducted based on the experiences of 16 patients with breast cancer recurrence and 2 oncologists to confirm the findings of the effective inhibiting and facilitating factors in patients’ decisions to start retreatment for breast cancer recurrence in one of the hospitals in Tehran, Iran. The samples were selected, using the purposeful sampling method trying to have maximum diversity. Data were collected through in-depth semi-structured telephone interviews from November 2020 to November 2021 and analyzed, using the conventional content analysis method following the Elo and Kyngas method, which includes 3 phases, including the preparation phase, the organizing phase, and the reporting phase. Credibility, transferability, dependability, confirmability, and authenticity were used for determining the trustworthiness of data. Results: Both groups of inhibiting and facilitating factors were divided into 5 categories, including individual factors, social factors, family factors, illness characteristics, and treatment-related factors. Also, each category included sub-categories in two groups of inhibiting and facilitating factors affecting the decision to start treatment again. Conclusions: Based on the results of the present study, it is necessary to increase the awareness of patients with breast cancer by the treatment staff about the possibility of recurrence and to know the factors influencing their decision-making process to start retreatment. Nurses should play the role of advisors, educators, and supporters of the patients in this field.
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Fiddimore E, Harrop E, Nelson A, Sivell S. "I don't want to hear statistics, I want real life stories": Systematic review and thematic synthesis of patient and caregiver experiences of Proton Beam Therapy. J Psychosoc Oncol 2022; 41:434-456. [PMID: 37155324 DOI: 10.1080/07347332.2022.2136997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PROBLEM IDENTIFICATION Proton Beam Therapy (PBT) is an advanced form of radiotherapy, yet little evidence exists on patient experience to inform decision making and improve future care. We thematically synthesized the qualitative evidence of patient and caregivers' perceptions and experiences of PBT. LITERATURE SEARCH Five electronic databases were systematically searched, using Medical Subject Headings (MeSH) terms and keywords. Two reviewers independently screened search results for qualitative studies relating to patients' and caregivers' experiences of PBT. The search generated 4,020 records, of which nine were eligible. Study quality (assessed by CASP checklist) varied. DATA SYNTHESIS Qualitative results were analyzed using thematic synthesis. Three main themes were generated: decision making and perceptions, living in the PBT "bubble," and coping with the cancer treatment journey. CONCLUSIONS PBT is not yet widely accessible worldwide, which uniquely influences the patient experience. Our review uncovers areas PBT providers could target to improve patient-centered care; however, additional primary qualitative research is recommended.
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Affiliation(s)
- Emma Fiddimore
- iBSc in Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Emily Harrop
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Pel E, Engelberts I, Schermer M. Diversity of interpretations of the concept "patient-centered care for breast cancer patients"; a scoping review of current literature. J Eval Clin Pract 2022; 28:773-793. [PMID: 34002460 PMCID: PMC9788211 DOI: 10.1111/jep.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patient-centered care is considered a vital component of good quality care for breast cancer patients. Nevertheless, the implementation of this valuable concept in clinical practice appears to be difficult. The goal of this study is to bridge the gap between theoretical elaboration of "patient-centered care" and clinical practice. To that purpose, a scoping analysis was performed of the application of the term "patient-centered care in breast cancer treatment" in present-day literature. METHOD For data-extraction, a literature search was performed extracting references that were published in 2018 and included the terms "patient-centered care" and "breast cancer". The articles were systematically traced for answers to the following three questions: "What is patient-centered care?", "Why perform patient-centered care?", and "How to realize patient-centered care?". For the content analysis, these answers were coded and assembled into meaningful clusters until separate themes arose which concur with various interpretations of the term "patient-centered care". RESULTS A total of 60 publications were retained for analysis. Traced answers to the three questions "what", "why", and "how" varied considerably in recent literature concerning breast cancer treatment. Despite the inconsistent use of the term "patient-centered care," we did not find any critical consideration about the nature of the concept, regardless of the applied interpretation. Interventions that are supposed to contribute to the heterogeneous concept of patient-centered care as such, seem to be judged desirable, virtually without empirical justification. CONCLUSIONS We propose, contrary to previous efforts to define "patient-centered care" more accurately, to embrace the heterogeneity of the concept and apply "patient-centered care" as an umbrella-term for all healthcare that intends to contribute to the acknowledgement of the person in the patient. For the justification of measures to realize patient-centered care for breast cancer patients, instead of a mere contribution to the abstract concept, we insist on the demonstration of desirable real-world effects.
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Affiliation(s)
- Elise Pel
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands
| | - Ingeborg Engelberts
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands.,The Franciscus Breast Clinic, Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | - Maartje Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Center of Rotterdam, Rotterdam, The Netherlands
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Yang Y, Xie M, Zhang L, Yu K, Li H, Sun W, Feng Z, Tang Y, Ma H, Wang Q, Wu G, Yang K, Wu B. Characteristics of older-patient-specif ic oncological trials: a cross-sectional analysis of ClinicalTrials.gov. Age Ageing 2022; 51:6568538. [PMID: 35429270 DOI: 10.1093/ageing/afac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND clinical trials dedicated to the older patients with cancer are essential to help to define optimal cancer therapy for this rapidly growing population. Our study aimed to analyse the characteristics and the evolution of older-patient-specific oncological trials registered in ClinicalTrials.gov. METHODS a dataset of 61,120 oncological trials registered in ClinicalTrials.gov between 2000 and 2019 was downloaded. Characteristics of older-patient-specific trials were compared with characteristics of age-unspecified trials. Chronological shifts in older-patient-specific trials were also analysed. RESULTS of the 49,273 interventional trials eligible for analysis, only 490 (1.0%) were older-patient-specific. More than half of the older-patient-specific trials were phase 2 and enrolled less than 100 patients. Compared with age-unspecified trials, older-patient-specific trials were less likely to be funded by industry (26.9 vs 37.1%), and more likely to be conducted in Europe (44.5 vs 28.3%). During the two time periods between 2000 and 2009, and 2010 and 2019, the proportion of supportive care-oriented trials increased from 1.9 to 13.9%. Concerningly, the use of clinically meaningful end points in older patients such as disease-specific survival, patient-reported outcomes and functional status as a primary end point was uncommon (0.4, 8.1 and 7.3%, respectively). There was no correlation between the number of trials for a given cancer type and relative incidence and mortality. 196/490 (40.0%) of the trials were conducted for patients with haematological cancer. CONCLUSION our study helps us to better understand the current state of older-patient-specific oncological trials and provide insights for future development, resulting in the improvement of the care of older patients with cancer.
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Affiliation(s)
- Yun Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - He Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wei Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zishan Feng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yun Tang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Haotian Ma
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qingpeng Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province Clinical Research Center for Medical Imaging, Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Liu J, Hunter S, Zhu J, Lee RLT, Chan SWC. Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol. BMJ Open 2022; 12:e058425. [PMID: 35301213 PMCID: PMC8932263 DOI: 10.1136/bmjopen-2021-058425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Women with early-stage breast cancer (EBC) are commonly required to make treatment decisions. Decision regret regarding treatments is an adverse outcome that negatively affects women's psychological well-being and quality of life. A systematic review will be conducted to synthesise evidence about decision regret among women regarding treatments for EBC. The study will focus on levels of decision regret, what is regretted, and the factors associated with decision regret. METHODS AND ANALYSIS A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Electronic databases, including CINAHL Complete, Embase, PubMed, Medline and Web of Science, will be searched for relevant articles published from 2000 to 2021. The reference lists of eligible studies will also be manually searched. All types of quantitative, qualitative and mixed-methods studies that report on decision regret regarding treatments among women with EBC will be included. The primary outcome of this review will be women's levels of decision regret regarding breast cancer treatments. The secondary outcomes will include the content of their regrets, and the factors contributing to decision regret. The methodological quality of the studies will be assessed using the Joanna Briggs Institute appraisal tools. Meta-analysis and thematic synthesis approaches will be used to synthesise quantitative and qualitative data, respectively. A convergent parallel approach will be used to integrate quantitative and qualitative findings. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The findings of this work will be disseminated at international conferences and peer-reviewed journals. The findings of this systematic review will inform the development of decision interventions to improve the decision outcomes of breast cancer treatments. PROSPERO REGISTRATION NUMBER CRD42021260041.
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Affiliation(s)
- Jing Liu
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Regina Lai-Tong Lee
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sally Wai-Chi Chan
- President Office, Tung Wah College, Hong Kong, People's Republic of China
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11
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Song CV, Yip CH, Mohd Taib NA, See MH, Teoh LY, Monninkhof EM, Saad M, Uiterwaal CSPM, Bhoo-Pathy N. Association Between Adherence to Clinical Practice Guidelines for Adjuvant Therapy for Breast Cancer and Survival in a Resource-Limited Setting. JCO Glob Oncol 2022; 8:e2100314. [PMID: 35245099 PMCID: PMC8920448 DOI: 10.1200/go.21.00314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Addressing unwarranted clinical variation in oncology practices is expected to lead to improved cancer outcomes. Particularly, the application and impact of treatment guidelines on breast cancer outcomes are poorly studied in resource-limited settings. We measured adherence to a set of locally developed adjuvant treatment guidelines in a middle-income setting. Importantly, the impact of guidelines adherence on survival following breast cancer was determined. METHODS Data of 3,100 Malaysian women with nonmetastatic breast cancer diagnosed between 2010 and 2017 were analyzed. Adherence to the Malaysian Clinical Practice Guidelines for Management of Breast Cancer second Edition was measured. Outcomes comprised overall survival and event-free survival. RESULTS Guideline adherence for chemotherapy, radiotherapy, hormonal therapy, and targeted therapy were 61.7%, 79.2%, 85.1%, and 26.2%, respectively. Older age was generally associated with lower adherence to guidelines. Compared with patients who were treated according to treatment guidelines, overall survival and event-free survival were substantially lower in patients who were not treated accordingly; hazard ratios for all-cause mortality were 1.69 (95% CI, 1.29 to 2.22), 2.59 (95% CI, 1.76 to 3.81), 3.08 (95% CI, 1.94 to 4.88), and 4.48 (95% CI, 1.98 to 10.13) for chemotherapy, radiotherapy, hormone therapy, and targeted therapy, respectively. Study inferences remain unchanged following sensitivity analyses. CONCLUSION Our study findings appear to suggest that adherence to treatment guidelines that have been adapted for resource-limited settings may still provide effective guidance in improving breast cancer outcomes. Non-adherence to local breast cancer CPG worsens survival in Malaysia.![]()
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Affiliation(s)
- Chin Vern Song
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Subang Jaya, Malaysia
| | | | - Mee Hoong See
- Department of Surgery, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Li Ying Teoh
- Department of Surgery, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Marniza Saad
- Department of Clinical Oncology, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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12
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Angarita FA, Oshi M, Yamada A, Yan L, Matsuyama R, Edge SB, Endo I, Takabe K. Low RUFY3 expression level is associated with lymph node metastasis in older women with invasive breast cancer. Breast Cancer Res Treat 2022; 192:19-32. [PMID: 35018543 PMCID: PMC8844209 DOI: 10.1007/s10549-021-06482-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Sentinel lymph node biopsy is omitted in older women (≥ 70 years old) with clinical lymph node (LN)-negative hormone receptor-positive breast cancer as it does not influence adjuvant treatment decision-making. However, older women are heterogeneous in frailty while the chance of recurrence increase with improving longevity. Therefore, a biomarker that identifies LN metastasis may facilitate treatment decision-making. RUFY3 is associated with cancer progression. We evaluated RUFY3 expression level as a biomarker for LN-positive breast cancer in older women. METHODS Clinical and transcriptomic data of breast cancer patients were obtained from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC, n = 1903) and The Cancer Genome Atlas (TCGA, n = 1046) Pan-cancer study cohorts. RESULTS A total of 510 (METABRIC) and 211 (TCGA) older women were identified. LN-positive breast cancer, which represented 51.4% (METABRIC) and 48.4% (TCGA), demonstrated worse disease-free, disease-specific, and overall survival. RUFY3 levels were significantly lower in LN-positive tumors regardless of age. The area under the curve for the receiver operator characteristic (AUC-ROC) curves showed RUFY3-predicted LN metastasis. Low RUFY3 enriched oxidative phosphorylation, DNA repair, MYC targets, unfolded protein response, and mtorc1 signaling gene sets, was associated with T helper type 1 cell infiltration, and with intratumor heterogeneity and fraction altered. Low RUFY3 expression was associated with LN-positive breast cancer and with worse disease-specific survival among older women. CONCLUSION Older women with breast cancers who had low expression level of RUFY3 were more frequently diagnosed with LN-positive tumors, which translated into worse prognosis.
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Affiliation(s)
- Fernando A. Angarita
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Masanori Oshi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA;,Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Akimitsu Yamada
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Li Yan
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Stephen B. Edge
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA;,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA;,Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan;,Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York, USA;,Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan;,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan
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13
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Stamuli E, Corry S, Ross D, Konstantopoulou T. Patient preferences for breast cancer treatments: a discrete choice experiment in France, Ireland, Poland, Spain. Future Oncol 2022; 18:1115-1132. [PMID: 35043660 DOI: 10.2217/fon-2021-0635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To understand breast cancer patients' trade-offs when choosing treatments and to identify the most important treatment attributes which drive decisions. Materials & methods: A discrete choice experiment was conducted in France, Ireland, Poland and Spain. Progression-free survival, febrile neutropenia, pain, functional well-being and out-of-pocket payment were the treatment attributes. Results: 371 patients were willing to pay €6896 per year for 1 additional year of progression-free survival, €17,288 per year for perfect functional well-being and €15,138 for one pain-free year. Patients are willing to trade off progression-free survival months for better functional abilities and less pain. Conclusion: Patient preferences should be considered by regulatory agencies, reimbursement bodies, payors and clinicians for best treatment choices for the individuals.
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Affiliation(s)
- Eugena Stamuli
- Pharmecons Easy Access Ltd, Health Economics and Outcomes Research (HEOR), York YO31 0AA, UK
| | - Sorcha Corry
- Novartis Ireland Limited, Vista Building, Elm Park Business Campus, Merrion Road, IE- Dublin 4,Ireland
| | - Derek Ross
- Centre for Innovative Human Systems, School of Psychology Trinity College Dublin, The University of Dublin, College Green, Dublin 2 D02 PN40, Ireland
| | - Thomais Konstantopoulou
- Novartis Oncology Region Europe, Novartis Farma S.p.A., Largo Umberto Boccioni 1I-21040, Origgio / VA Italy
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14
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Angarita FA, Hoppe EJ, Ko G, Lee J, Vesprini D, Hong NJL. Why do Older Women Avoid Breast Cancer Surgery? A Qualitative Analysis of Decision-making Factors. J Surg Res 2021; 268:623-633. [PMID: 34474211 DOI: 10.1016/j.jss.2021.06.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies have explored why older women (≥70 years old) avoid breast cancer surgery. This study aimed to identify physician- and patient-perceived attitudes that influence the decision to avoid surgery among older women with invasive breast cancer. METHODS Semi-structured in-depth interviews were conducted with multidisciplinary breast cancer specialists and older women (≥70 years old) with breast cancer who declined surgery. Transcripts were iteratively coded using a theoretical framework to guide identification of common themes. Thematic comparison was performed between patients and physicians. RESULTS Ten breast cancer specialists and eleven patients participated. Physicians believed older women declined surgery because they did not perceive breast cancer as a life-threatening ailment compared to other medical comorbidities. Physicians did not discuss breast reconstruction, as it was perceived to be unimportant. Treatment side effects, length of treatment, impact on quality of life, and minimal survival benefit strongly influenced patients' decision to decline surgery. Patients valued independence and quality of life over quantity of life. Patients felt empowered to participate in the decision-making process but appreciated having support. Both phyisicians and patients had congruent beliefs with respect to age impacting treatment decision, cosmesis playing a minor factor in treatment decisions, and importance of quality of life; however, they were discordant in their perceptions about the amount of support that patients have from their families. CONCLUSIONS The decision to avoid surgery in older women stems from a variety of individual beliefs. Acknowledging patient values early in treatment planning may facilitate a patient-centered approach to the decision-making process.
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Affiliation(s)
| | - Ethan J Hoppe
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gary Ko
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Lee
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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15
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Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review. Cancer Nurs 2021; 44:E670-E686. [PMID: 34294647 DOI: 10.1097/ncc.0000000000000981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Deciding to have a mastectomy can be challenging for women. An understanding of the decision-making experience related to mastectomy would contribute to improving the support of women making this decision. OBJECTIVE The aim of this study was to understand women's decision-making experience related to mastectomy. METHODS Studies published from 2000 to 2020 were identified by searching databases (CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science, and China National Knowledge Infrastructure) and reference lists of previous reviews. Methodological quality of these studies was assessed using the Mixed Methods Appraisal Tool version 2018. Data were analyzed using content comparison analysis. RESULTS Twenty-three quantitative and 6 qualitative studies were included in this review. Four themes emerged from the included studies: participation in decision-making, seeking information about treatment choices, postoperative perceptions of mastectomy decision-making, and factors related to mastectomy choice. Several negative experiences related to decision-making were identified. A number of clinical, sociodemographic, and psychosocial factors that influenced women to choose a mastectomy were identified. CONCLUSIONS This review provides in-depth information about decision-making experiences and factors that influence the choice of mastectomy. Research is required about women who have had a mastectomy using standardized instruments to investigate their decision-making experiences. Studies are also necessary in non-Western countries. IMPLICATIONS FOR PRACTICE The factors and experiences identified in this review may help nurses to assist in the treatment decision-making process. Further research is required regarding breast care and other nurses' involvement in the decision-making process related to mastectomy.
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16
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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Angarita FA, Zhang Y, Elmi M, Look Hong NJ. Older women's experience with breast cancer treatment: A systematic review of qualitative literature. Breast 2020; 54:293-302. [PMID: 33242756 PMCID: PMC7695983 DOI: 10.1016/j.breast.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background The experience of older women during breast cancer treatment is insufficiently described by quantitative studies. This study aimed to systematically review qualitative data describing factors that influence older women’s (≥65 years old) experience with breast cancer treatment. Methods A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) principles. MEDLINE, CINAHL, PsycINFO, and EMBASE were searched (inception – 2020). Quality assessment of essential item reporting was performed using the Standards for Reporting Qualitative Research (SRQR) criteria. Common ideas were coded, thematically organized, and synthesized within a theoretical framework. Results Of 7,773 studies identified, twelve were included. The median SRQR score was 13.4 (range 11.3–15.9) (maximum score: 21). Data synthesis revealed that older women experienced breast cancer as a journey with challenges during each phase. During diagnosis, they delayed seeking medical help despite symptoms. Age and experience gave them perspective on the impact of their diagnosis. During decision-making, preconceptions and personal values determined choices. In the treatment phase, women experienced medical and social barriers to care. During the post-treatment phase, many experienced treatment adverse effects, but could move on or compartmentalize as coping mechanisms. Conclusion Older women with breast cancer have unique challenges specific to each phase of their treatment journey. Older women may benefit from proactive treatment discussions with health care providers to address their specific needs, individualize care, and assist with cancer care navigation. Older women have challenges specific to each phase of their treatment journey. Older women experience barriers to care and depended on their social network. Older women could conceptually move on or compartmentalize as coping mechanisms. Physicians should be aware of the unique features of each treatment phase.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - Yimeng Zhang
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Maryam Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5T 1P5, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada; Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada.
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18
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Paxino J, Denniston C, Woodward-Kron R, Molloy E. Communication in interprofessional rehabilitation teams: a scoping review. Disabil Rehabil 2020; 44:3253-3269. [PMID: 33096000 DOI: 10.1080/09638288.2020.1836271] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Effective communication in interprofessional rehabilitation teams is essential for optimal patient care. Despite the established importance, it remains unclear how interprofessional communication (IPC) within teams contributes to rehabilitation service delivery. The aim of this scoping review was to investigate how IPC has been described in rehabilitation literature. METHODS Databases (Medline, CINAHL, ERIC, Embase, PsychInfo, and Academic Search Complete) were searched for studies including rehabilitation interprofessional communication. Inclusion and exclusion criteria were identified and applied, data were charted, and thematic analysis conducted. RESULTS Twenty-nine papers were identified, and analysis revealed interrelated themes: communication processes, and inputs and effects. Formal communication processes were most prevalent, portraying variability in professional participation and a lack of patient involvement in dialogue and decision making. Inputs and effects were described at an organisational, team and individual level, highlighting the importance of communication throughout the healthcare hierarchy. CONCLUSIONS IPC in rehabilitation is central to effective team function and patient care. To further our understanding, empirical studies examining everyday informal IPC, as well as formal ritualised encounters are needed. Additionally, conceptualisations of IPC would benefit from including the patients' perspective and by using theoretical framing to attend to places, spaces, and artefacts identified in this review.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Charlotte Denniston
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
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19
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Zhang W, Xu J, Wang K, Tang XJ, Liang H, He JJ. Independent risk factors for axillary lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes. BMC WOMENS HEALTH 2020; 20:143. [PMID: 32646416 PMCID: PMC7350751 DOI: 10.1186/s12905-020-01004-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
Background The benefit of axillary lymph node dissection (ALND) in breast cancer patients with one or two positive sentinel lymph nodes (SLNs) remains inconclusive. The purpose of this study was to identify risk factors independently associated with axillary lymph node (ALN) metastasis. Methods We retrospectively analyzed data from 389 Chinese breast cancer patients with one or two positive SLNs who underwent ALND. Univariate and multivariate logistic regression analyses were performed to identify ALN metastasis-associated risk factors. Results Among the 389 patients, 174 (44.7%) had ALN metastasis, while 215 (55.3%) showed no evidence of ALN metastasis. Univariate analysis revealed significant differences in age (< 60 or ≥ 60 years), human epidermal growth factor receptor-2 (Her-2) status, and the ratio of positive to total SLNs between the ALN metastasis and non-metastasis groups (P < 0.05). The multivariate analysis indicated that age, the ratio of positive to total SLNs, and occupations were significantly different between the two groups. Lastly, younger age (< 60 years), a higher ratio of positive to total SLNs, and manual labor jobs were independently associated with ALN metastasis (P < 0.05). Conclusions The risk of ALN metastasis in breast cancer patients with one or two positive SLNs can be further increased by younger age, manual labor jobs, and a high ratio of positive to total SLNs. Our findings may also aid in identifying which patients with one or two positive SLNs may not require ALND.
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Affiliation(s)
- Wei Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Jing Xu
- Department of Geriatric Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Xiao-Jiang Tang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China
| | - Hua Liang
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Rd., Xi'an, 710061, Shaanxi, China.
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20
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Karakatsanis A, Markopoulos C. The challenge of avoiding over- and under-treatment in older women with ductal cancer in situ: A scoping review of existing knowledge gaps and a meta-analysis of real-world practice patterns. J Geriatr Oncol 2020; 11:917-925. [PMID: 32146094 DOI: 10.1016/j.jgo.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/25/2020] [Accepted: 02/18/2020] [Indexed: 01/03/2023]
Abstract
Ductal cancer in situ (DCIS) is mainly a screen-detected disease and although the risk for breast cancer is age-dependent, most screening programs do not include women over the age of 75 years. Older women are usually excluded from clinical trials and treatment practices are largely based on observational studies or extrapolation of trial results from younger patients, leading to either over- or under-treatment of this population. We systematically reviewed available electronic databases for DCIS treatment patterns and outcomes in older patients 15 years. Inclusion criteria allowed for randomised controlled trials, cohort studies, case-control and cross-sectional studies, as well as meta-analyses, systematic reviews and position papers. Results showed that, although elderly are not necessarily frail, they are generally treated as such by physicians, aiming to de-escalate therapeutic interventions. After adjusting for frailty, age seems to be a significant factor for less surgery; however, older women with DCIS are more probable to receive surgery than their counterparts with early invasive cancer. DCIS biology and subtypes are independent risk factors for local recurrence or progression to invasive carcinoma, if DCIS is under-treated. The end-benefit of surgery, radio- and endocrine-therapy depend on additional parameters, such as life expectancy, co-morbidities and competing risks of death. Screen-detected DCIS in older women is a challenging clinical problem, mainly due to the lack of high-level data. Therapeutic strategies should be tailored to life expectancy and performance status, DCIS features and patient preference, aiming at combining optimal oncological outcomes with maintenance of quality of life.
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Affiliation(s)
- Andreas Karakatsanis
- Section for Endocrine and Breast Surgery, Department for Surgical Sciences, Uppsala University, Uppsala, Sweden.
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21
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Xu H, Zhang XJ, Wang DQ, Xu L, Wang AP. Factors influencing medication-taking behaviour with adjuvant endocrine therapy in women with breast cancer: A qualitative systematic review. J Adv Nurs 2019; 76:445-458. [PMID: 31657028 DOI: 10.1111/jan.14253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022]
Abstract
AIMS To explore the experience and feelings associated with the endocrine therapy treatment trajectory in women with breast cancer and what affects medication taking behaviour. DESIGN Qualitative systematic review. DATA SOURCES Qualitative studies were extracted from PubMed, EMBASE, CINAHL, PsycINFO from inception of each database until February 2019. REVIEW METHODS The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of the qualitative data was used. RESULTS A total of 478 were identified in the initial search. Only 17 articles met inclusion criteria and were included in this review. Five analytical themes and 17 descriptive subthemes were identified. CONCLUSIONS The systematic review highlights knowledge, balancing the scales, self-efficacy and support influence medication taking behaviour to women with breast cancer. IMPACT The medication taking behaviour of breast cancer women can be classified into four types: acceptance/persistence, bearing/suffering, hesitation/adjustment, refusing/abandoning. The four types can switch from one to another. Medication taking behaviour is affected by knowledge, balancing the scales, self-efficacy, and support. The medical institutions, communities, and families can gain knowledge of the treatment experiences of women to better understand medication taking behaviour and those at risk for non-adherence. Women wanted different types and amounts of information. Healthcare providers should be aware of patient preferences and take targeted interventions to help them receive treatment.
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Affiliation(s)
- Hui Xu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Insititute, Shenyang, China
| | - Xiu-Jie Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Da-Qiu Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Lei Xu
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ai-Ping Wang
- Department of Nursing, The First Affiliated Hospital of China Medical University, Shenyang, China
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22
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Omori Y, Enatsu S, Cai Z, Ishiguro H. Patients' preferences for postmenopausal hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer treatments in Japan. Breast Cancer 2019; 26:652-662. [PMID: 30949915 PMCID: PMC6694082 DOI: 10.1007/s12282-019-00965-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/23/2019] [Indexed: 12/24/2022]
Abstract
Background This study aimed to identify factors affecting patients’ preferences for postmenopausal hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer treatments, their relative importance, and impact of sociodemographic/clinical characteristics. Methods Japanese postmenopausal patients with HR+ breast cancer chose between 2 hypothetical treatments for HR+/HER2− advanced breast cancer using an online discrete choice experiment, defined by different levels of 5 attributes: progression-free survival (PFS), incidence of diarrhea (IOD), frequency of loose stools of grade 1–3 severity (FOS), duration of diarrhea (DOD), and route/frequency of administration (RFA). Conditional logit modeling identified relative preferences for each attribute. Subgroup analyses, based on sociodemographic characteristics (age, employment status, age of youngest child, marital status) and clinical characteristics (relapse/metastasis, hormone sensitivity), identified factors affecting preferences. Results Of 896 participants screened, 258 eligible participants were included in analyses. Patient preferences, when the potential frequency of diarrhea was grade 2, were (strongest to weakest): PFS, DOD, FOS, IOD, RFA; however, when the potential frequency of diarrhea was grade 3, FOS became most important. Sociodemographic/clinical characteristics tended to affect preferences. Conclusions Japanese postmenopausal patients with HR+ breast cancer preferred treatments that extend PFS despite potential grade 2 diarrhea. However, when diarrhea severity increased to grade 3, patients were more willing to sacrifice PFS to avoid more frequent diarrhea. Prevention or limitation of diarrhea to grade ≤ 2 is important for maintaining patients’ motivation for treatment that can extend PFS. Additionally, patient characteristics (age, family context, therapeutic experience) should be considered during treatment choice. Electronic supplementary material The online version of this article (10.1007/s12282-019-00965-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yukie Omori
- Eli Lilly Japan K.K., Medicines Development Unit Japan, Akasaka Garden City 13F, 4-15-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Sotaro Enatsu
- Eli Lilly Japan K.K., Medicines Development Unit Japan, 5-1-28, Isogamidori, Chuo-ku, Kobe, Japan
| | - Zhihong Cai
- Eli Lilly Japan K.K., Medicines Development Unit Japan, Akasaka Garden City 13F, 4-15-1, Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| | - Hiroshi Ishiguro
- International University of Health and Welfare Hospital, Nasushiobara, Japan
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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