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Abstract
BACKGROUND The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care. METHODS The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included. RESULTS The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction. CONCLUSIONS Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
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Shao J, Rodrigues M, Corter AL, Baxter NN. Multidisciplinary care of breast cancer patients: a scoping review of multidisciplinary styles, processes, and outcomes. Curr Oncol 2019; 26:e385-e397. [PMID: 31285683 PMCID: PMC6588064 DOI: 10.3747/co.26.4713] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Clinical practice guidelines recommend a multidisciplinary approach to cancer care that brings together all relevant disciplines to discuss optimal disease management. However, the literature is characterized by heterogeneous definitions and few reviews about the processes and outcomes of multidisciplinary care. The objective of this scoping review was to identify and classify the definitions and characteristics of multidisciplinary care, as well as outcomes and interventions for patients with breast cancer. Methods A systematic search for quantitative and qualitative studies about multidisciplinary care for patients with breast cancer was conducted for January 2001 to December 2017 in the following electronic databases: medline, embase, PsycInfo, and cinahl. Two reviewers independently applied our eligibility criteria at level 1 (title/abstract) and level 2 (full-text) screening. Data were extracted and synthesized descriptively. Results The search yielded 9537 unique results, of which 191 were included in the final analysis. Two main types of multidisciplinary care were identified: conferences and clinics. Most studies focused on outcomes of multidisciplinary care that could be variously grouped at the patient, provider, and system levels. Research into processes tended to focus on processes that facilitate implementation: team-working, meeting logistics, infrastructure, quality audit, and barriers and facilitators. Summary Approaches to multidisciplinary care using conferences and clinics are well described. However, studies vary by design, clinical context, patient population, and study outcome. The heterogeneity of the literature, including the patient populations studied, warrants further specification of multidisciplinary care practice and systematic reviews of the processes or contexts that make the implementation and operation of multidisciplinary care effective.
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Affiliation(s)
- J Shao
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Rodrigues
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - A L Corter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - N N Baxter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
- Department of Surgery, St. Michael's Hospital, Toronto, ON
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
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Ng YYR, Tan VKM, Goh TLH, Yong WS, Wong CY, Ho GH, Madhukumar P, Ong KW, Ong YS, Sim Y, Tan BK, Tan BKT. Trends in Post-Mastectomy Reconstruction in an Asian Population: A 12-Year Institutional Review. Breast J 2016; 23:59-66. [PMID: 27633549 DOI: 10.1111/tbj.12682] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Post-mastectomy breast reconstruction is an integral component of breast cancer treatment. It is often perceived that women in Asian countries have a lower rate of post-mastectomy reconstruction than Western populations. This study describes trends in timing and types of breast reconstruction performed in the largest healthcare provider in Singapore, over a period of 12 years. It also reports on the oncological outcomes and surgical safety. A retrospective review of all patients who underwent post-mastectomy reconstruction from January 2001 to December 2012 at the National Cancer Centre Singapore and Singapore General Hospital was performed. Six hundred and twenty post-mastectomy reconstructions were performed in 579 patients. The proportion of reconstructions increased from 4% in 2001 to 18% in 2012. Younger patients (<50 years old) and those with early stage cancer were more likely to undergo reconstruction. Immediate breast reconstruction was favored by more than 90% of patients. Postoperatively, 9% developed acute surgical complications that were treated surgically; 6% had additional surgery for late complications. Only 4% had delay of adjuvant chemotherapy. At median follow-up of 63 months (range 3-166), loco-regional recurrence was 4%, and distant metastases 8%. Post-mastectomy reconstruction for breast cancer is increasingly performed in our institution. Both younger age and lower stage disease were associated with choice for reconstruction in our study. Low rates of delay to adjuvant therapy were noted, and it may safely be offered to suitable women undergoing mastectomy.
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Affiliation(s)
- Yvonne Ying Ru Ng
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Veronique Kiak Mien Tan
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Terence Lin Hon Goh
- Department of Plastics, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Wei Sean Yong
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Chow Yin Wong
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Gay Hui Ho
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Preetha Madhukumar
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Kong Wee Ong
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Yee Siang Ong
- Department of Plastics, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Yirong Sim
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Bien Keem Tan
- Department of Plastics, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
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Chan SWW, Cheung C, Chan A, Cheung PSY. Surgical options for Chinese patients with early invasive breast cancer: Data from the Hong Kong Breast Cancer Registry. Asian J Surg 2016; 40:444-452. [PMID: 27209473 DOI: 10.1016/j.asjsur.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Breast conserving surgery (BCS) is preferred for suitable candidates, while mastectomy (MTX) with reconstruction (MTX + R) is considered a better option for patients requiring MTX. In Hong Kong, the rates of BCS and breast reconstruction are relatively low. This paper aims to study the surgical options and their predictors among Hong Kong breast cancer patients. METHODS Data is retrieved from the Hong Kong Breast Cancer Registry (HKBCR) from 2007 to 2013. A total of 4519 Stage I-II breast cancer patients who had surgical treatments were included in this retrospective study. RESULTS Our multivariate logistic regression shows that people who were younger (age < 40 years: OR, 1.5; 95% CI, 1.1-2.1; p = 0.010), more educated (undergraduate/postgraduate: OR, 2.8; 95% CI, 1.7-4.4; p < 0.0001), never married (OR, 1.5; 95% CI, 1.1-1.9; p = 0.002), had regular mammography screening (OR, 1.5; 95% CI, 1.3-1.8; p < 0.0001), had screen-detected cancers (OR, 1.3; 95% CI, 1.0-1.6; p = 0.031), and who underwent surgery at a private medical service facility (OR, 1.8; 95% CI, 1.6-2.2; p < 0.0001) were more likely to receive BCS. In addition, people who were younger (age < 40 years: OR, 15.9; 95% CI, 6.5-39.2; p < 0.0001), more educated (undergraduate/postgraduate: OR, 26.8; 95% CI, 3.6-201.4; p = 0.001), had regular mammography screening (OR, 1.6; 95% CI, 1.1-2.3; p = 0.008), had screen-detected cancers (OR, 2.1; 95% CI, 1.4-3.3; p = 0.001), and had smaller tumor (≤ 2.0 cm: OR, 0.39; 95% CI, 0.20-0.76; p = 0.005) were more likely to have reconstruction after MTX. CONCLUSION Chinese patients have lower BCS and breast reconstruction rate. Besides cultural difference, patient-related factors such as age, education, marital status, mammography screening, the use of private medical facilities, and clinical characteristics including smaller tumor size and peripherally located tumor were significant predictors for type of surgical treatments in Chinese women with early breast cancer.
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Affiliation(s)
- Sharon W W Chan
- Kowloon East Cluster Breast Centre, Department of Surgery, United Christian Hospital, Hong Kong, China.
| | | | - Amy Chan
- Hong Kong Breast Cancer Foundation, Hong Kong, China
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Si W, Li Y, Han Y, Zhang F, Wang Y, Li Y, Linghu RX, Zhang X, Yang J. Epidemiological and Clinicopathological Trends of Breast Cancer in Chinese Patients During 1993 to 2013: A Retrospective Study. Medicine (Baltimore) 2015; 94:e820. [PMID: 26131834 PMCID: PMC4504600 DOI: 10.1097/md.0000000000000820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study aimed to summarize the epidemiological and pathological trends of breast cancer in Chinese women.The clinical data of 4968 breast cancer patients treated at the Chinese PLA General Hospital from 1993 to 2013 were retrospectively reviewed.The mean ± standard deviation (SD) age was 47.4 ± 11.3 years before the year 2001, 49.2 ± 11.2 years during 2001 to 2010, and 50.6 ± 11.4 years after the year 2010, respectively (P < 0.001). The ratio of premenopausal women to postmenopausal women was 1.6 and no significant changes were found during the period (P = 0.121). The proportion of patients with Scarff Bloom Richardson III breast cancer showed significant increase along with time (P = 0.015). The breast cancer was accounting for 31.7% at stage I and DCIS/LCIS and tend to be diagnosed with early stage around time (P < 0.001). The proportion of DCIS/LCIS and stage I increased with time during the 20 years from 14.6% to 33.2%, whereas the proportion of stage III to IV decreased.The proportion of Luminal A-like subtype gradually reduced and Luminal B-like (HER2-negative) increased and developed to the predominant type. Older age and earlier stage at diagnosis, as well as the alternation of predominant molecular subtypes, have become the developed trends of breast cancer.
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Affiliation(s)
- Wen Si
- From the Department of Medical Oncology I, General Hospital of the Chinese People's Liberation Army, Beijing (WS, YH, FZ, YW, YL, RXL, XZ, JY); School of Medicine, Nankai University, Tianjin (WS, YH); and Department of Medical Oncology, Beijing Geriatric Hospital, Haidian District (YL)
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Yeo W, Lee HM, Chan A, Chan EYY, Chan MCM, Chan KW, Chan SWW, Cheung FY, Cheung PSY, Choi PHK, Chor JSY, Foo WWL, Kwan WH, Law SCK, Li LPK, Tsang JWH, Tung Y, Wong LLS, Wong TT, Yau CC, Yau TK, Zee BCY. Risk factors and natural history of breast cancer in younger Chinese women. World J Clin Oncol 2014; 5:1097-1106. [PMID: 25493246 PMCID: PMC4259937 DOI: 10.5306/wjco.v5.i5.1097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/20/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients.
METHODS: Seven thousand one hundred and fifty-two women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients’ consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger (< 40 years old) vs older patients (≥ 40 years old) for subsequent analyses.
RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise (85.4% vs 73.2%, P < 0.001), having high stress in life (46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets (20.2% vs 12.9%, P < 0.001), having alcohol drinking habit (7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity (43.3% vs 17.8%, P < 0.001) and an early age at menarche (20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology (45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion (39.6% vs 33.2%, P = 0.003), and having multifocal disease (15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.
CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.
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Wang LW, Yang GF, Chen JM, Yang F, Yuan JP, Sun SR, Chen C, Hu MB, Li Y. A clinical database of breast cancer patients reveals distinctive clinico-pathological characteristics: a study from central China. Asian Pac J Cancer Prev 2014; 15:1621-6. [PMID: 24641378 DOI: 10.7314/apjcp.2014.15.4.1621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignant tumor in females worldwide. Many differences exist in clinico-pathological characteristics of breast cancer patients between China and Western countries. This study aimed to analyze clinico-pathological characteristics of breast cancer from central China. METHODS Clinico- pathological information on breast cancer from three hospitals in central China was collected and analyzed. RESULTS From 1994 to 2012, 2,525 patients with a median age 50 years were included in this study. The 45-49-year age group and invasive ductal carcinoma not otherwise specified accounted for the highest proportions (19.1%, 480/2,525 and 81.0%, 1,982/2,446). Stages 0-I, II and III accounted for 28.0% (682/2,441), 48.4% (1,180/2,441), and 23.7% (578/2,441), respectively. Distribution of N stage showed that N0 accounted for 53.2% (1,344/2,525), and proportion of N0 rose from 51.1% (157/307) in 30-39-year age group to 64.3% (110/171) in ≥ 70-year age group, with an average increase of 2.1% in each age group. Modified radical mastectomy, radical mastectomy, breast-conserving surgery and simple mastectomy were performed for 71.8% (1,812/2,525), 18.0% (454/2,525), 5.2% (131/2,525) and 2.6% (66/2,525), respectively. Proportions of breast-conserving surgery in age ≤ 44-year group (68/132, 51.5%) and simple mastectomy in age ≥ 60-year group (57/89, 64.0%) were higher than in the other age groups. Breast cancers positive for estrogen receptor accounted for 53.0% (1,107/ 2,112). The comparisons among this study and other reports showed higher proportion of younger patients, lower proportion of breast- conserving surgery and positive estrogen receptor patients in China than western countries. CONCLUSIONS Clinico-pathological characteristics in this study demonstrated clear differences between the center of China than Western countries. Additional classification systems should be developed to guide grading of early breast cancer more accurately, especially for N0 patients. Invasive ductal carcinoma is a focus for intensive research.
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Affiliation(s)
- Lin-Wei Wang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China E-mail :
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Bhatti ABH, Jamshed A, Khan A, Siddiqui N, Muzaffar N, Shah MA. Comparison between early and late onset breast cancer in Pakistani women undergoing breast conservative therapy: is there any difference? Asian Pac J Cancer Prev 2014; 15:5331-6. [PMID: 25040997 DOI: 10.7314/apjcp.2014.15.13.5331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early onset breast cancer is associated with poor outcomes but variable results have been reported. It is a significant problem in Pakistani women but remains under reported. Breast conservation plays an important role in surgical management of this younger patient group. The objective of this study was to determine the outcome of breast conservative therapy in patients with early onset breast cancer in our population and compare it with their older counterparts. MATERIALS AND METHODS A review of patients with invasive breast cancer who underwent breast conservation surgery at Shaukat Khanum Cancer Hospital from 1997 to 2009 was performed. Patients were divided into two groups i.e. Group I age ≤ 40 and Group II >40 years. A total of 401 patients with breast cancer were identified in Group I and 405 patients in Group II. Demographics, histopathological findings and receptor status of the two groups were compared. The Chi square test was used for categorical variables. Outcome was assessed on basis of 10 year locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS) . For survival analysis Kaplan Meier curves were used and significance was determined using the Log rank test. Cox regression was applied for multivariate analysis. RESULTS Median follow up was 4.31 (0.1-15.5) years. Median age at presentation was 34.6 years (17-40) and 51.9 years (41-82) for the two groups. Groups were significantly different from each other with respect to grade, receptor status, tumor stage and use of neoadjuvant therapy. No significant difference was present between the two groups for estimated 10 year LRRFS (86% vs 95%) (p=0.1), DFS (70% vs 70%) (p=0.5) and OS (75% vs 63%) (p=0.1). On multivariate analysis, tumor stage was an independent predictor of LRRFS, DFS and OS. CONCLUSIONS Early onset breast cancer is associated with a distinct biology but does not lead to poorer outcomes in our population.
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Affiliation(s)
- Abu Bakar Hafeez Bhatti
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town Lahore, Pakistan E-mail :
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Adjuvant chemotherapy increases the prevalence of fat necrosis in immediate free abdominal flap breast reconstruction. J Plast Reconstr Aesthet Surg 2014; 67:461-7. [PMID: 24530060 DOI: 10.1016/j.bjps.2014.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/22/2013] [Accepted: 01/03/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fat necrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fat necrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fat necrosis prevalence remains unknown. METHODS Our initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fat necrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS The overall prevalence of fat necrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fat necrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fat necrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fat necrosis than those without fat necrosis, although this tendency was not statistically significant. CONCLUSIONS Our initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fat necrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.
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Pang A, Ho S, Lee SC. Cancer physicians' attitude towards treatment of the elderly cancer patient in a developed Asian country. BMC Geriatr 2013; 13:35. [PMID: 23590357 PMCID: PMC3654995 DOI: 10.1186/1471-2318-13-35] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/08/2013] [Indexed: 11/17/2022] Open
Abstract
Background With an aging population and an increasing number of elderly patients with cancer, it is essential for us to understand how cancer physicians approach the management and treatment of elderly cancer patients as well as their methods of cancer diagnosis disclosure to older versus younger patients in Singapore, where routine geriatric oncology service is not available. Methods 57 cancer physicians who are currently practicing in Singapore participated in a written questionnaire survey on attitudes towards management of the elderly cancer patient, which included 2 hypothetical clinical scenarios on treatment choices for a fit elderly patient versus that for a younger patient. Results The participants comprised of 68% medical oncologists, 18% radiation oncologists, and 14% haematologists. Most physicians (53%) listed performance status (PS) as the top single factor affecting their treatment decision, followed by cancer type (23%) and patient’s decision (11%). The top 5 factors were PS (95%), co-morbidities (75%), cancer stage (75%), cancer type (75%), patient’s decision (53%), and age (51%). 72% of physicians were less likely to treat a fit but older patient aggressively; 53% and 79% opted for less intensive treatments for older patients in two clinical scenarios of lymphoma and early breast cancer, respectively. 37% of physicians acknowledged that elderly cancer patients were generally under-treated. Only 9% of physicians chose to disclose cancer diagnosis directly to the older patient compared to 61% of physicians to a younger patient, citing family preference as the main reason. Most participants (61%) have never engaged a geriatrician’s help in treatment decisions, although the majority (90%) would welcome the introduction of a geriatric oncology programme. Conclusions Advanced patient age has a significant impact on the cancer physician’s treatment decision-making process in Singapore. Many physicians still accede to family members’ request and practice non-disclosure of cancer diagnosis to geriatric patients, which may pose as a hurdle to making an informed decision regarding management for the geriatric cancer patients. Having a formal geriatric oncology programme in Singapore could potentially help to optimize the management of geriatric oncology patients.
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Affiliation(s)
- Angela Pang
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Level 7, Tower Block, 1E, Kent Ridge Road, Singapore, 119228, Singapore
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Li J, Zhang BN, Fan JH, Pang Y, Zhang P, Wang SL, Zheng S, Zhang B, Yang HJ, Xie XM, Tang ZH, Li H, Li JY, He JJ, Qiao YL. A nation-wide multicenter 10-year (1999-2008) retrospective clinical epidemiological study of female breast cancer in China. BMC Cancer 2011; 11:364. [PMID: 21859480 PMCID: PMC3178543 DOI: 10.1186/1471-2407-11-364] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the very limited cancer registry, incidence and mortality rates for female breast cancer in China are regarded to be increasing especially in the metropolitan areas. Representative data on the breast cancer profile of Chinese women and its time trend over years are relatively rare. The aims of the current study are to illustrate the breast cancer profile of Chinese women in time span and to explore the current treatment approaches to female breast cancer. METHODS This was a hospital-based nation-wide and multi-center retrospective study of female primary breast cancer cases. China was divided into 7 regions according to the geographic distribution; from each region, one tertiary hospital was selected. With the exception of January and February, one month was randomly selected to represent each year from year 1999 to 2008 at every hospital. All inpatient cases within the selected month were reviewed and related information was collected based on the designed case report form (CRF). The Cancer Hospital/Institute, Chinese Academy of Medical Sciences (CICAMS) was the leading hospital in this study. RESULTS Four-thousand two-hundred and eleven cases were randomly selected from the total pool of 45,200 patients and were included in the analysis. The mean age at diagnosis was 48.7 years (s.d. = 10.5 yrs) and breast cancer peaked in age group 40-49 yrs (38.6%). The most common subtype was infiltrating ductal carcinoma (86.5%). Clinical stage I & II accounted for 60.6% of 4,211 patients. Three-thousand five-hundred and thirty-four cases had estrogen receptor (ER) and progestin receptor (PR) tests, among them, 47.9% were positive for both. Two-thousand eight-hundred and forty-nine cases had human epidermal growth factor receptor 2(HER-2) tests, 25.8% of them were HER-2 positive. Among all treatment options, surgery (96.9% (4,078/4,211)) was predominant, followed by chemotherapy (81.4% (3,428/4,211). Much less patients underwent radiotherapy (22.6% (952/4,211)) and endocrine therapy (38.0% (1,599/4,211)). CONCLUSIONS The younger age of breast cancer onset among Chinese women and more advanced tumor stages pose a great challenge. Adjuvant therapy, especially radiotherapy and endocrine therapy are of great unmet needs.
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Affiliation(s)
- Jing Li
- Dept, of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, China
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