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Bertucci F, Le Corroller-Soriano AG, Monneur A, Fluzin S, Viens P, Maraninchi D, Goncalves A. [E-health and "Cancer outside the hospital walls", Big Data and artificial intelligence]. Bull Cancer 2019; 107:102-112. [PMID: 31543271 DOI: 10.1016/j.bulcan.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 12/25/2022]
Abstract
To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.
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Affiliation(s)
- François Bertucci
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France.
| | - Anne-Gaëlle Le Corroller-Soriano
- Aix-Marseille université, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Inserm UMR912, 13009 Marseille, France
| | - Audrey Monneur
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France
| | - Sylvain Fluzin
- Institut Paoli-Calmettes, direction du système d'information et de l'organisation, 13009 Marseille, France
| | - Patrice Viens
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Dominique Maraninchi
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 13009 Marseille, France; Aix-Marseille université, Centre de recherche en cancérologie de Marseille, Inserm U1068-CNRS U7258, 13009 Marseille, France
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Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on "Cancer outside the Hospital Walls". Cancers (Basel) 2019; 11:cancers11020219. [PMID: 30769858 PMCID: PMC6406853 DOI: 10.3390/cancers11020219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/06/2019] [Accepted: 02/10/2019] [Indexed: 01/21/2023] Open
Abstract
In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less "invasive", with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of "cancer outside the hospital walls" from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.
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Mitchell G, Porter S, Manias E. From telling to sharing to silence: A longitudinal ethnography of professional‐patient communication about oral chemotherapy for colorectal cancer. Psychooncology 2018; 28:336-342. [DOI: 10.1002/pon.4945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gary Mitchell
- School of Nursing and MidwiferyQueen's University Belfast Belfast Northern Ireland, UK
| | - Sam Porter
- Department of Social Sciences & Social WorkBournemouth University Dorset England, UK
| | - Elizabeth Manias
- School of Nursing & Midwifery, Centre for Quality and Patient Safety ResearchDeakin University Melbourne Australia
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Di Ciaccio M, Protiere C, Rojas Castro D, Suzan-Monti M, Chas J, Cotte L, Siguier M, Cua E, Spire B, Molina JM, Preau M. The ANRS-Ipergay trial, an opportunity to use qualitative research to understand the perception of the "participant"-physician relationship. AIDS Care 2018; 30:41-47. [PMID: 29848004 DOI: 10.1080/09540121.2018.1468013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The ANRS-IPERGAY trial consisted in providing sexual activity-based antiretroviral prophylaxis for HIV prevention (PrEP) with a package of prevention tools (counselling, condoms, HIV and sexually transmitted infections' screening) to highly exposed HIV-negative men who have sex with men (MSM). Few data exist concerning the patient-physician relationship in the particular context of PrEP, where physicians discuss sexual behaviours with MSM who are not classic patients, in that consultation is for prevention purposes, not for illness. This study took place during the open-label extension of ANRS-IPERGAY trial when all participants received PrEP. In this qualitative study, we examined how physicians perceived their relationship with participants in the ANRS-IPERGAY trial. Of all 30 physicians involved in the trial who were contacted by email to participate in an interview about their opinions and perceptions of ANRS-IPERGAY 18 volunteered to participate in the current sub-study. We performed a vertical analysis for each interview to identify the extract in each physician's discourse concerning their relationship with MSM participants, and conducted a horizontal analysis to construct the thematic tree and subsequently investigate differences and similitudes between themes. An analysis of all physicians' discourses showed that the participant-physician relationship during the trial could be described through 4 themes: (i) personal experience of the relationship, (ii) trust and non-judgement, (iii) positive relational climate and (iv) influence of physician's characteristics (age, gender, etc.) on relationship. We found that the particular context of PrEP led some physicians to adopt a patient-as-partner approach during consultations rather than a paternalist or hierarchical approach. Indeed, the close follow-up provided by the trial and the active role of patients in their own prevention care trajectory, are more compatible with the patient-as-partner approach. The prescription of PrEP may lead to an evolution in patient-physician relationships and may even modify the professional identity of physicians.
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Affiliation(s)
- Marion Di Ciaccio
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Christel Protiere
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Daniela Rojas Castro
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France.,d AIDES (Mission Innovation Recherche Expérimentation) , Pantin , France.,e Coalition Internationale Sida , programme recherche communautaire , Pantin , France
| | - Marie Suzan-Monti
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Julie Chas
- f Département des Maladies Infectieuses , Hôpital Tenon , Paris , France
| | - Laurent Cotte
- g Hôpital de la Croix Rousse, Département des Maladies Infectieuses , Centre Hospitalier et Universitaire de Lyon , Lyon , France
| | - Martin Siguier
- h Hospital Saint-Louis, Department of Infectious Diseases, Assistance Publique Hôpitaux de Paris , University of Paris Diderot Paris 7, INSERM U941 , Paris , France
| | - Eric Cua
- i Département des Maladies Infectieuses , Hôpital de l'Archet , Nice , France
| | - Bruno Spire
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Jean-Michel Molina
- h Hospital Saint-Louis, Department of Infectious Diseases, Assistance Publique Hôpitaux de Paris , University of Paris Diderot Paris 7, INSERM U941 , Paris , France
| | - Marie Preau
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France
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- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France
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Berger AM, Buzalko RJ, Kupzyk KA, Gardner BJ, Djalilova DM, Otte JL. Preferences and actual chemotherapy decision-making in the greater plains collaborative breast cancer study . Acta Oncol 2017; 56:1690-1697. [PMID: 28903664 DOI: 10.1080/0284186x.2017.1374555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is renewed interest in identifying breast cancer patients' participation in decision-making about adjuvant chemotherapy. There is a gap in the literature regarding the impact of these decisions on quality of life (QOL) and quality of care (QOC). Our aims were to determine similarities and differences in how patients diagnosed with breast cancer preferred to make decisions with providers about cancer treatment, to examine the patient's recall of her role when the decision was made about chemotherapy and to determine how preferred and actual roles, as well as congruence between them, relate to QOL and perceived QOC. MATERIAL AND METHODS Greater Plains Collaborative clinical data research network of PCORnet conducted the 'Share Thoughts on Breast Cancer' survey among women 12-18 months post-diagnosis at eight sites in seven Midwestern United States. Patients recalled their preferred and actual treatment decision-making roles and three new shared decision-making (SDM) variables were created. Patients completed QOL and QOC measurements. Correlations and t-tests were used. RESULTS Of 1235 returned surveys, 873 (full sample) and 329 (subsample who received chemotherapy) were used. About one-half of women in both the full (50.7%) and subsample (49.8%,) preferred SDM with providers about treatment decisions, but only 41.2% (full) and 42.6% (subsample) reported experiencing SDM. Significant differences were found between preferred versus actual roles in the full (p < .001) and subsample (p < .004). In the full sample, there were no relationships between five decision-making variables with QOL, but there was an association with QOC. The subsample's decision-making variables related to several QOL scales and QOC items, with a more patient-centered decision than originally preferred related to higher physical and social/family well-being, overall QOL and QOC. CONCLUSIONS Patients benefit from providers' efforts to identify patient preferences, encourage an active role in SDM, and tailor decision making to their desired choice.
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Affiliation(s)
- Ann M. Berger
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Russell J. Buzalko
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kevin A. Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bret J. Gardner
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Julie L. Otte
- School of Nursing, Indiana University, Indianapolis, IN, USA
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Protière C, Spire B, Mora M, Poizot-Martin I, Préau M, Doumergue M, Morlat P, Zucman D, Goujard C, Raffi F, Lambotte O, Suzan-Monti M. Patterns of patient and healthcare provider viewpoints regarding participation in HIV cure-related clinical trials. Findings from a multicentre French survey using Q methodology (ANRS-APSEC). PLoS One 2017; 12:e0187489. [PMID: 29095883 PMCID: PMC5667862 DOI: 10.1371/journal.pone.0187489] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/20/2017] [Indexed: 11/19/2022] Open
Abstract
Context Despite huge advances in the fight against HIV concerning diagnosis, clinical efficacy of antiretroviral treatments (ART), patient survival and quality of life, there is still no cure. Recent developments in HIV cure research have opened the way for clinical trials which could lead to a temporary or definitive end to ART. However, ethical questions exist about related trial-participation risks. The main goal of the ANRS-APSEC survey was, using Q-methodology, to investigate the viewpoints of people living with HIV (PLWH) and HIV healthcare providers (HHP) regarding motivations for and barriers to participation in HIV Cure-related clinical trials (HCRCT). Materials and methods Thirty-three statements were defined encompassing seven dimensions: treatment and follow-up; risks; benefits; patient-physician relationship; beliefs and attitudes; information; target population. Forty-one PLWH and 41 HHP from five French HIV services were asked to rank-order the statements. Results Five main viewpoints were elicited from “the most motivated” to “the most reluctant” vis-à-vis HCRCT participation. All placed importance on the wish to participate in HIV research. This result is in line with the HIV-specific culture of joint mobilization. For some viewpoints, the motivation to participate in/propose HCRCT was primarily conditioned by side-effects and/or by constraints, which overall were more accepted by PLWH than HHP. Some viewpoints placed particular importance on HCRCT recruitment strategies. Finally, some expressed a high acceptance of risks and constraints but emphasized the need for information. Conclusion HIV cure research clinical trials (HCRCT) constitute a risky yet unavoidable step towards the goal of finding a cure. To improve future HCRCT and informed consent designs, based on PLWH and HHP preferences and expectations, we need greater knowledge about how these populations perceive the risks and the benefits of HCRCT. Our results confirmed the importance of careful, studied HCRCT design, management and communication, to ensure PLWH and HHP acceptability and convergence of their expectations.
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Affiliation(s)
- Christel Protière
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- * E-mail:
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Isabelle Poizot-Martin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- Aix-Marseille Univ, CISIH, APHM, Hôpital Sainte-Marguerite, Marseille, France
| | - Marie Préau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- GRePS Lyon 2 Université, Bron, France
| | | | - Philippe Morlat
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint André, CHU de Bordeaux; Université de Bordeaux; INSERM U 1219; Bordeaux, France
| | - David Zucman
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - Cécile Goujard
- Assistance Publique—Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, Le Kremlin-Bicêtre, France
- Service de Santé publique, AP-HP et INSERM 1018, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Université Paris-Sud, Villejuif, France
| | - François Raffi
- University Hospital, Department of Infectious Diseases, Nantes, France
| | - Olivier Lambotte
- Assistance Publique—Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, Le Kremlin-Bicêtre, France
- INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
- Université Paris Sud, UMR 1184, Le Kremlin-Bicêtre, France
- CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Raoul JL, Maraninchi D. L’autonomie de décision du patient : du concept à la pratique cancérologique. Bull Cancer 2017; 104:695-700. [DOI: 10.1016/j.bulcan.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
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Moving towards shared decision making in the physician-patient encounter in France: State of the art and future prospects. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:41-45. [DOI: 10.1016/j.zefq.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Information needs of cancer patients: Validation of the Greek Cassileth's Information Styles Questionnaire. Eur J Oncol Nurs 2016; 20:49-57. [DOI: 10.1016/j.ejon.2015.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/07/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022]
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Mitchell G, Porter S, Manias E. A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol. J Adv Nurs 2014; 71:922-32. [DOI: 10.1111/jan.12565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Gary Mitchell
- Department of Employment and Learning; School of Nursing and Midwifery; Queen's University Belfast; UK
| | - Sam Porter
- School of Nursing and Midwifery; Queen's University Belfast; UK
| | - Elizabeth Manias
- School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne Victoria Australia
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Seror V, Cortaredona S, Bouhnik AD, Meresse M, Cluze C, Viens P, Rey D, Peretti-Watel P. Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery. Psychooncology 2013; 22:2546-56. [PMID: 23749441 DOI: 10.1002/pon.3316] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). METHODS A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. RESULTS The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. CONCLUSIONS Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.
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Affiliation(s)
- Valérie Seror
- INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France
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12
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Edery L, Bacqué MF. Faut-il être fou pour refuser sa chimiothérapie ? ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. PATIENT EDUCATION AND COUNSELING 2012; 86:9-18. [PMID: 21474265 PMCID: PMC4530615 DOI: 10.1016/j.pec.2011.02.004] [Citation(s) in RCA: 533] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population. METHODS Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure. RESULTS 115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported. CONCLUSION Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population. PRACTICE IMPLICATIONS The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.
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Affiliation(s)
- Betty Chewning
- Sonderegger Research Center, University of Wisconsin School of Pharmacy, Madison, WI 53705-2222, USA.
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Donetto S, Cribb A. Researching involvement in health care practices: interrupting or reproducing medicalization? J Eval Clin Pract 2011; 17:907-12. [PMID: 21848940 DOI: 10.1111/j.1365-2753.2011.01725.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this paper we reflect upon and problematize the ways in which 'patient involvement' is interpreted in a substantial proportion of the research literature on involvement and shared decision making. Drawing upon an analysis of this literature we raise concerns about the 'medicalization of involvement' embedded in, and reproduced by, some dominant research lenses, suggesting that this medicalization has powerful discursive and material effects. For example, we suggest that it tends to normalize and arguably trivialize intrinsically problematic and contentious concepts such as 'patient preferences' and, at the same time, to obscure the full range of possibilities for reciprocity in the exchanges between the medical world of the professional and the experiential and narrative world of the patient. We argue that richer conceptualizations of collaboration in clinical work are both possible and very much needed, and we indicate some examples of scholarly resources and perspectives that point towards richer and more defensible accounts of involvement. Overall we call for more attention to the idea of 'epistemic involvement' and much greater cross-fertilization between different epistemological paradigms in this area of research.
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Affiliation(s)
- Sara Donetto
- Centre for Public Policy Research, Department of Education and Professional Studies, King's College London, London, UK.
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Protière C, Moumjid N, Bouhnik AD, Le Corroller Soriano AG, Moatti JP. Heterogeneity of Cancer Patient Information-Seeking Behaviors. Med Decis Making 2011; 32:362-75. [DOI: 10.1177/0272989x11415114] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. This study aimed to determine whether cancer patients report different information-seeking behaviors (ISBs), investigate why they searched for information, and determine the relationship between their ISBs and their socioeconomic and behavioral characteristics. The authors also explored the relationship between ISB and participation in the medical decision-making process as well as the patients’ health state. Methods. A sample of 4270 French cancer survivors aged 18 or older was interviewed at 2 years following diagnosis. Rather than deciding a priori who should be considered an information seeker, the authors chose to statistically define the different ISBs using cluster analysis. Results. The authors identified 4 distinct profiles: Stereotypical high-information seekers and acquainted seekers are generally highly educated. They search for information due to their own motivation or because they are close to the medical profession. Constrained information seekers are characterized by a low socioeconomic status. They perceive themselves as “dropouts” of the health care system. Finally, the general information seekers did not systematically resort to any specific ISB. The authors show that after adjustment, belonging to a specific ISB was associated with the likelihood of participating in the medical decision-making process and, more surprisingly, with health state. Conclusions. A key finding of this study is that social disparities are significantly associated with the different ISBs. If these relationships are found in other samples, it would further support the need for medical teams to pay more attention to patients with lower levels of education, particularly in health care systems that have acknowledged equality as a founding principle. The clusters determined in this study offer a potential theoretical framework that can be used in future studies.
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Affiliation(s)
- Christel Protière
- INSERM, UMR-912 “Economic & Social Sciences, Health Systems & Societies” (SE4S), Marseille, France (CP, ADB, AGLCS, JPM)
- Université Aix-Marseille, IRD, Marseille, France (CP, ADB, AGL, JPM)
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne; CNRS, UMR 5824, GATE-LSE (NM)
| | - Nora Moumjid
- INSERM, UMR-912 “Economic & Social Sciences, Health Systems & Societies” (SE4S), Marseille, France (CP, ADB, AGLCS, JPM)
- Université Aix-Marseille, IRD, Marseille, France (CP, ADB, AGL, JPM)
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne; CNRS, UMR 5824, GATE-LSE (NM)
| | - Anne-Deborah Bouhnik
- INSERM, UMR-912 “Economic & Social Sciences, Health Systems & Societies” (SE4S), Marseille, France (CP, ADB, AGLCS, JPM)
- Université Aix-Marseille, IRD, Marseille, France (CP, ADB, AGL, JPM)
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne; CNRS, UMR 5824, GATE-LSE (NM)
| | - Anne Gaëlle Le Corroller Soriano
- INSERM, UMR-912 “Economic & Social Sciences, Health Systems & Societies” (SE4S), Marseille, France (CP, ADB, AGLCS, JPM)
- Université Aix-Marseille, IRD, Marseille, France (CP, ADB, AGL, JPM)
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne; CNRS, UMR 5824, GATE-LSE (NM)
| | - Jean Paul Moatti
- INSERM, UMR-912 “Economic & Social Sciences, Health Systems & Societies” (SE4S), Marseille, France (CP, ADB, AGLCS, JPM)
- Université Aix-Marseille, IRD, Marseille, France (CP, ADB, AGL, JPM)
- Université de Lyon, F-69622, Lyon, France; Université Lyon 1, Villeurbanne; CNRS, UMR 5824, GATE-LSE (NM)
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Gravis G, Protière C, Eisinger F, Boher JM, Tarpin C, Coso D, Cappiello MA, Camerlo J, Genre D, Viens P. Full access to medical records does not modify anxiety in cancer patients. Cancer 2011; 117:4796-804. [DOI: 10.1002/cncr.26083] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/26/2011] [Accepted: 02/11/2011] [Indexed: 11/12/2022]
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Heiwe S, Kajermo KN, Tyni-Lenné R, Guidetti S, Samuelsson M, Andersson IL, Wengström Y. Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals. Int J Qual Health Care 2011; 23:198-209. [PMID: 21242158 DOI: 10.1093/intqhc/mzq083] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susanne Heiwe
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Zhang Y, Su H, Shang L, Li D, Wang R, Zhang R, Xu Y. Preferences and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis. Med Decis Making 2010; 31:245-53. [PMID: 20709961 DOI: 10.1177/0272989x10375990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The objectives of this study were to measure the preferences for and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis and to explore the factors that may influence patients' preferences. The study also aimed to analyze patients' satisfaction with decision and information provision and their relationships with the decisional role. METHODS Semistructured interviews were performed with 178 chronic hepatitis patients. The Control Preferences Scale was translated into Chinese from English and adopted to measure patients' preferred and perceived decisional role. Patients' satisfaction with decision and information provision was also investigated by a 5-point Likert-type scale. RESULTS Patients with chronic hepatitis in the study generally preferred a collaborative role (45%) or passive role (44%); only 11% of patients preferred an active role in treatment decision making. The agreement between patients' perceived and preferred role was not perfect (Bowker's S = 33.8, P < 0.001). Age and education level were significantly associated with patients' preferences: Younger, better educated patients tended to prefer more active roles. A total of 54% of patients felt satisfied with treatment decisions, whereas 39% of patients felt satisfied with information provision. Patients' levels of satisfaction with their treatment decisions were correlated not only with the perceived role itself but also with its agreement with the preferred role. Patients' satisfaction with information provision was significantly correlated with patients' preferred role. Moreover, there was a significant correlation between patients' satisfaction with the treatment decision and information provision. CONCLUSIONS Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and preferred decisional role.
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Affiliation(s)
- Yuhai Zhang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Haixia Su
- Department of Epidemiology (HS) Fourth Military Medical University, Xi’an, China
| | - Lei Shang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Duan Li
- Tangdu Hospital (DL) Fourth Military Medical University, Xi’an, China
| | - Rui Wang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Ruiqiao Zhang
- Sanatorium Center for Retired Cadre (RZ), Fourth Military Medical University, Xi’an, China
| | - Yongyong Xu
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
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Almyroudi A, Degner LF, Paika V, Pavlidis N, Hyphantis T. Decision-making preferences and information needs among Greek breast cancer patients. Psychooncology 2010; 20:871-9. [DOI: 10.1002/pon.1798] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/23/2010] [Accepted: 05/31/2010] [Indexed: 11/12/2022]
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20
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Carretier J, Bataillard A, Fervers B. La place du patient dans la médecine factuelle. ACTA ACUST UNITED AC 2009; 146:537-44. [DOI: 10.1016/j.jchir.2009.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Masya LM, Young JM, Solomon MJ, Harrison JD, Dennis RJ, Salkeld GP. Preferences for outcomes of treatment for rectal cancer: patient and clinician utilities and their application in an interactive computer-based decision aid. Dis Colon Rectum 2009; 52:1994-2002. [PMID: 19934920 DOI: 10.1007/dcr.0b013e3181c001b9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To quantify the importance that patients and clinicians assign to specific quality-of-life outcomes associated with the treatment of rectal cancer and to demonstrate a clinical application of these data in a computer-based multidimension decision aid (Annalisa). METHODS For patients, a researcher-administered questionnaire using the time trade-off method was used to quantify the importance of nine outcomes. Information was ascertained from clinicians by use of a self-administered questionnaire. Responses were ranked and compared between groups. Mean values for each outcome were entered into Annalisa. RESULTS Overall, 103 patients, 87 colorectal surgeons, 97 medical oncologists, and 80 radiation oncologists participated. For all groups, local cancer recurrence in the pelvis and fecal incontinence (mean utility scores 0.53 and 0.57, respectively) were the two outcomes to most avoid. In Annalisa, the "best fit" treatment for patients and surgeons was a low anterior resection with postoperative chemotherapy, whereas for medical and radiation oncologists the best-fit treatment was surgery alone. CONCLUSION Local recurrence and fecal incontinence are considered the worst outcomes by patients and clinicians alike, but values for other outcomes vary. Decision aids that incorporate patients' individual values with evidence-based data hold considerable potential to optimize treatment decision-making.
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Affiliation(s)
- Lindy M Masya
- Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service and School of Public Health, University of Sydney, New South Wales, Australia
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Epstein RJ, Leung TW, Mak J, Cheung PS. Utility of a Web-Based Breast Cancer Predictive Algorithm for Adjuvant Chemotherapeutic Decision Making in a Multidisciplinary Oncology Center. Cancer Invest 2009; 24:367-73. [PMID: 16777688 DOI: 10.1080/07357900600705292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Adjuvant drug therapy can extend survival for breast cancer patients, but the balance between costs and benefits may be difficult to estimate. Software programs have been developed for this purpose and recently have become available online. Here, we describe our experience using a web-based program to support adjuvant decision making at a multidisciplinary breast cancer Tumor Board in a university-affiliated oncology center. PATIENTS AND METHODS One hundred two adjuvant breast cancer cases were discussed by the Tumor Board over a four-month period, with a provisional treatment plan being formulated after each discussion. Program data predicting 10-year risks and benefits were shared with board members after each provisional plan and any change in recommendation was recorded. A user survey was conducted to assess the perceived strengths and weaknesses of the program. RESULTS Treatment decisions were changed in 12.7 percent of cases (13/102) after consideration of data from the program. Most of these (76.9 percent) were node-negative ER-positive cases, with the most common reason for change being a lower-than-expected added survival benefit from less intensive chemotherapy regimens (ACx4 or CMF; 81.8 percent). In certain recurrent scenarios, the program was perceived to have limitations that led to retention of the original management plan despite data that might otherwise have favored different treatment. On completion of the study period, clinicians' attitudes to the program ranged from enthusiasm to caution. CONCLUSION Although not replacing clinical judgement, these findings support the value of this web-based program as a decision making adjunct that can help clinicians to separate risk and benefit, compare the added value of different therapeutic interventions in a given clinical context, and present more balanced information about treatment options to patients.
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Kind P, Lafata JE, Matuszewski K, Raisch D. The use of QALYs in clinical and patient decision-making: issues and prospects. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 1:S27-S30. [PMID: 19250128 DOI: 10.1111/j.1524-4733.2009.00519.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Paul Kind
- Outcomes Research Group, Centre for Health Economics, Alcuin College, University of York, York, UK.
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Masood S. Significance of Patient Education and Counseling in Improving Breast Healthcare. WOMENS HEALTH 2008; 4:551-5. [DOI: 10.2217/17455057.4.6.551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shahla Masood
- Shahla Masood, MD, Professor & Chair, Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA and, Medical Director, Shands Jacksonville Breast Health Center, FL, USA, Tel.: +1 904 244 4387, Fax: +1 904 244 4060,
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Vogel BA, Bengel J, Helmes AW. Information and decision making: patients' needs and experiences in the course of breast cancer treatment. PATIENT EDUCATION AND COUNSELING 2008; 71:79-85. [PMID: 18191933 DOI: 10.1016/j.pec.2007.11.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 10/26/2007] [Accepted: 11/24/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study explored breast cancer patients' preferences and experiences in receiving information and decision making in the course of the first 6 months of cancer treatment. METHODS Participants were 135 German breast cancer patients, recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy. Women were asked to complete a self-explanatory questionnaire at baseline and 3 and 6 months later. RESULTS There was a significant decrease in the importance of specific information needs. The quality of received information through the physician was rated significantly better at baseline than 6 months later. Nearly half of all patients changed their decision making preference at least at one assessment point. Shared decision making rarely took place in the first 6 months of treatment. CONCLUSION Breast cancer patients' information needs and decision making preferences can change during treatment. Future research should analyse which patients change their decision making preference under which circumstances. PRACTICE IMPLICATIONS Physicians need to investigate the decision making preferences and information needs of their patients in the course of treatment. Patient oriented communication skills might be helpful to meet patients' preferences and needs.
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Affiliation(s)
- Barbara A Vogel
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Germany.
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Moumjid N, Brémond A, Mignotte H, Faure C, Meunier A, Carrère MO. Shared decision-making in the physician-patient encounter in France: a general overview. ACTA ACUST UNITED AC 2007; 101:223-8. [PMID: 17601176 DOI: 10.1016/j.zgesun.2007.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In France, patients' claim for information and participation to medical decision-making was initiated in the eighties by AIDS associations, then reinforced by the tainted blood scandal and more recently by demands from cancer patients. The right to patient information was recognised on March 4th 2002 by the law pertaining to patients' rights and the quality of the healthcare system. The present article will explore this background by examining the bases, the current status and the development of shared decision-making in the physician-patient encounter in France. We will describe the evolution of the physician-patient relationship on the basis of legal and administrative documents, then show that patients' information, and more generally healthcare users' information, is a central concern for some national health institutions. Finally, we will demonstrate that even if the literature on shared decision-making is little developed in France as compared to other European countries, Northern America and Australia, some studies have nonetheless been conducted. Their results, combined with a legal context and national health institutions encouraging shared decision-making, should prompt otherwise reluctant healthcare professionals to implement this approach in everyday medical practice.
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Affiliation(s)
- Nora Moumjid
- GRESAC, GATE (UMR 5824) -CNRS, Lyon 2 University, Lyon 1 University, ENS LSH, Lyon, France.
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Toledano AH, Bollet MA, Fourquet A, Azria D, Gligorov J, Garaud P, Serin D, Bosset JF, Miny-Buffet J, Favre A, LeFoch O, Calais G. Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients’ and Doctors’ Views. Int J Radiat Oncol Biol Phys 2007; 68:66-72. [PMID: 17448869 DOI: 10.1016/j.ijrobp.2006.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 11/25/2006] [Accepted: 12/28/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. METHODS AND MATERIALS From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. RESULTS Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p = 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (kappa = 0.62). CONCLUSION After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis.
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Affiliation(s)
- Alain H Toledano
- Department of Radiation Oncology, Hôpital Tenon, AP-HP, Paris, France.
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Han S, Kim J, Sohn S, Kwak GH, Kim JY, Park K. Feasibility of concurrent adjuvant chemotherapy and radiotherapy after breast-conserving surgery in early breast cancer. J Surg Oncol 2007; 95:45-50. [PMID: 17192866 DOI: 10.1002/jso.20715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The optimal sequence of chemotherapy (CT) and radiotherapy (RT) remains uncertain after breast-conserving surgery (BCS). The current study was performed to evaluate whether the concurrent RT with CT increases the toxicities. METHODS Two hundred and thirty-eight patients with stages I and II breast cancers were prospectively allocated to concurrent CT and RT (n = 133) and sequential CT and RT (n = 105) after BCS. In the sequential group, RT was started after the completion of three cycles of CT and additional three cycles of CT were delivered after RT. RESULTS There was no significant difference in Grade 3 or 4 hematologic toxicities during CT between the two groups. Radiation related adverse effects were not different between the two groups. During the median follow-up period of 42 months (range: 16-60 months), 18 patients (13.5%) of the concurrent group had systemic recurrence of breast cancer, whereas 20 patients (19.1%) of the sequential group had systemic recurrence. Disease-free survival and local recurrence were not different between the two groups. CONCLUSIONS Concurrent CT and RT were not associated with increased toxicity and showed reasonable cosmetic results. The current study indicates that concurrent RT and CT after BCS is a feasible treatment modality with an advantage of shortening the treatment time.
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Affiliation(s)
- Sehwan Han
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, South Korea.
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Florin J, Ehrenberg A, Ehnfors M. Patient participation in clinical decision-making in nursing: a comparative study of nurses' and patients' perceptions. J Clin Nurs 2006; 15:1498-508. [PMID: 17118072 DOI: 10.1111/j.1365-2702.2005.01464.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role. BACKGROUND Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences. METHODS A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. RESULTS A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. CONCLUSIONS Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation. RELEVANCE TO CLINICAL PRACTICE A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.
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Affiliation(s)
- Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden.
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Timmermans LM, van der Maazen RWM, van Spaendonck KPM, Leer JWH, Kraaimaat FW. Enhancing patient participation by training radiation oncologists. PATIENT EDUCATION AND COUNSELING 2006; 63:55-63. [PMID: 16644175 DOI: 10.1016/j.pec.2005.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 08/19/2005] [Accepted: 08/22/2005] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Several studies have shown that patients' active participation to their medical interaction is beneficial for their information processing and their quality of life. Unfortunately, cancer patients often act rather passively in contact with their oncologists. We investigated whether cancer patients' participation in radiation therapy consultations could be enhanced by specific communicative behaviours of the radiation oncologists (ROs). METHODS Eight ROs and 160 patients participated; 80 patients in the pre training group and 80 patients in the post training group. The ROs were trained to use specific communicative behaviours that are supposed to encourage patient participation. In the training special attention was paid to communicative requirements in the first minutes of the consultation. The communicative behaviours of the ROs and the cancer patients were measured by the Roter Interaction Analysis System, and compared before and after the RO training. RESULTS From the start throughout the entire consultation, patients in the post training group participated more in interactions than patients in the pre training group: they discussed more psychosocial issues, expressed more concerns and contributed more to decision-making. CONCLUSION Cancer patients' participation in the initial radiation oncology consultations can be increased by training of ROs. PRACTICE IMPLICATIONS The results suggest that doctors working with cancer patients should receive communication training and feedback on a regular base.
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Affiliation(s)
- Liesbeth M Timmermans
- Department of Medical Psychology, 840 Medical Psychology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Kahán Z, Varga K, Dudás R, Nyári T, Thurzó L. Collaborative/active participation per se does not decrease anxiety in breast cancer. Pathol Oncol Res 2006; 12:93-101. [PMID: 16799710 DOI: 10.1007/bf02893451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 03/20/2006] [Indexed: 10/21/2022]
Abstract
The information needs of breast cancer patients on their disease, its treatment, the prognosis, and their attitude to decision-making concerning treatment were assessed. One hundred and fifty early and 45 metastatic breast cancer patients were recruited into the study. The amount of information and role in the treatment decision-making process preferred by the patient were independently estimated by the patient and the oncologist, using questionnaires. Information was provided in accordance with the wishes of the patient as perceived by the physician. Test of anxiety was performed before, and one week after the consultation. Most of the patients claimed to anticipate the provision of extensive information and an active role in the decision-making, but real interest during the consultation was found less frequently. The post-consultation anxiety test revealed a significant decrease in situational anxiety; this was not related to the patient's information needs or her attitude to the decision-making concerning treatment. Our study demonstrates that a significant decrease in anxiety may be achieved via a consultation tailored to the needs of the patient. Loading the patient with information and involvement in the decision regarding therapy as much as the patient seems comfortable with lowers distress.
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Affiliation(s)
- Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, H-6720, Hungary.
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Jakobsson S, Horvath G, Ahlberg K. A grounded theory exploration of the first visit to a cancer clinic—strategies for achieving acceptance. Eur J Oncol Nurs 2005; 9:248-57. [PMID: 16112526 DOI: 10.1016/j.ejon.2004.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate cancer patients' experiences of their first visit to a cancer clinic. Nine patients with various cancer diagnoses about to receive curative cancer treatment were interviewed after their first visit to the clinic. A qualitative research approach based on Grounded Theory was used throughout the research process. The data analysis gave rise to a process leading to a core category which showed how patients can reach acceptance of the impact cancer has on their lives. Five different categories were identified as being important for reaching acceptance, namely action, knowledge, respect, continuity and confidence. The patients expressed the need for receiving treatment for their cancer without delay, and for continuity in their care. They needed to be given individualized, relevant information about their illness and to be treated with respect. If these needs were met a feeling of confidence resulted. Meeting all of these needs helped patients accept the impact cancer had on their lives, as did confidence in the care being given. Acceptance was reached when patients felt they could actively participate in treatment decisions, when they knew what to expect and when they felt they were being treated as individuals. Health care professionals should be aware of these needs, and should try to treat their patients as individuals and thus help them to achieve acceptance.
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Affiliation(s)
- Sofie Jakobsson
- Institute of Nursing, Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg S-430 45, Sweden.
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Bellon JR, Shulman LN, Come SE, Li X, Gelman RS, Silver BJ, Harris JR, Recht A. A prospective study of concurrent cyclophosphamide/methotrexate/5-fluorouracil and reduced-dose radiotherapy in patients with early-stage breast carcinoma. Cancer 2004; 100:1358-64. [PMID: 15042668 DOI: 10.1002/cncr.20136] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concurrent administration of chemotherapy and radiotherapy has the potential advantage of delaying neither treatment and providing radiation sensitization. However, the optimal approach to concurrent treatment in women with early-stage breast carcinoma remains undefined. We present updated results of a prospective protocol of concurrent cyclophosphamide/methotrexate/5-fluorouracil (CMF) and reduced-dose radiotherapy, focusing on tumor control and patient tolerance. METHODS One hundred twelve women with AJCC Stage I or Stage II breast carcinoma with 0-3 positive axillary lymph nodes were enrolled in a prospective single-arm study of concurrent CMF and reduced-dose radiotherapy (39.6 gray [Gy] to the whole breast, 16-Gy boost). A high proportion of women had risk factors associated with an increased risk of local disease recurrence, including age <40 (32%), close or positive margins (37%), or lymphatic/vascular invasion (51%). The median follow-up period was 94 months. RESULTS The 5-year overall survival rate was 94%. By 60 months, 5 patients (4%) experienced local disease recurrence and 19 patients (17%) experienced distant metastasis. There were no isolated regional lymph node recurrences. Local disease recurrence occurred in 1 of 25 patients (4%), 1 of 16 patients (6%), and 3 of 70 patients (4%) with positive, close (<1 mm), and negative margins, respectively. One patient developed acute myelogenous leukemia. An additional patient developed Grade 2 pneumonitis. Cosmetic results were not recorded uniformly for all patients and therefore could not be reliably analyzed. CONCLUSIONS Concurrent CMF and reduced-dose radiotherapy resulted in a low level of late toxicity and excellent local tumor control, despite the large proportion of patients with substantial risk factors for local disease recurrence. Future studies of concurrent regimens, particularly in patients at high risk of local disease recurrence, are warranted.
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Affiliation(s)
- Jennifer R Bellon
- Department of Radiation Oncology, Brigham and Women's Hospital and the Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Recht A. Integration of systemic therapy and radiation therapy for patients with early-stage breast cancer treated with conservative surgery. Clin Breast Cancer 2003; 4:104-13. [PMID: 12864938 DOI: 10.3816/cbc.2003.n.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is no consensus on the optimal combination of systemic therapy and radiation therapy for patients with early-stage breast cancer treated with conservative surgery. This article reviews prospective and retrospective studies that shed light on this topic. Patients with positive, close, or unknown microscopic margins appear to benefit from relatively early initiation of radiation therapy, whereas those with wider tumor-free margin widths do not. For patients at high risk of distant failure (such as those with = 4 positive axillary nodes), chemotherapy may be more effective when it begins before radiation therapy rather than after. Regimens of concurrent radiation therapy and chemotherapy tend to have higher acute and subacute complication rates than sequential regimens, but the actual rates vary substantially with the exact details of the overall treatment program. There are no data on the impact of the timing of tamoxifen administration on the effectiveness of radiation therapy. Tamoxifen does not appear to increase complication rates relative to the use of radiation therapy alone. Thus, the best way of giving combined-modality therapy is uncertain. Further retrospective and prospective studies to investigate the issues discussed herein should be performed.
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Affiliation(s)
- Abram Recht
- Department of Radiation Oncology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA,USA.
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Abstract
BACKGROUND Patient participation in decision-making has produced many debates among health care professionals. The research evidence concerning patient participation in decision-making is not clear, and shows conflicting results. AIMS To identify to what extent cancer patients participate in decision-making and to what extent background characteristics, information obtained and relationships with staff explain cancer patients' participation in decision-making. DESIGN/METHOD A structured questionnaire based on earlier research and qualitative interviews was designed. The questionnaire was completed by 273 cancer patients who were inpatients or outpatients in haematology, oncology clinics and other clinics at two university hospitals in Finland. The questionnaire consisted of five areas: (1) demographic data; (2) mood; (3) information obtained; (4) relationships with staff; and (5) decision-making. The scale used was ordinal. The data were analysed using descriptive statistics and nonparametric tests such as Mann-Whitney U-test, Kruskall-Wallis, and Wilcoxon matched-pairs signed-rank tests. RESULTS The majority of the respondents perceived that they had participated in making treatment decisions at least to some extent, together with the physician. In decision-making about nursing care, respondents felt that they had participated most in decisions about personal hygiene, rest and sleep. Respondents' physical condition, marital status, age and time since diagnosis, as well as information obtained and relationships with staff, were associated with participation in decision-making. CONCLUSION This study provided evidence that some cancer patients participated in decision-making and felt participation to be important. Staff played a crucial role in patient participation in decision-making. In future, staff should work to improve cancer patients' opportunities to participate in decision-making in order that those who wish to be involved can do so.
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Affiliation(s)
- Carita Sainio
- Health Care Region of Helsinki and Uusimaa, HUCH Cancer Center, Helsinki, Finland.
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Arnaud S, Houvenaeghel G, Julian-Reynier C, Protière C, Moatti JP. [Women's preferences for early discharge after conservative breast surgery: feasibility, patient profile and satisfaction]. ANNALES DE CHIRURGIE 2003; 128:26-33. [PMID: 12600325 DOI: 10.1016/s0003-3944(02)00003-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Ours aims were to assess the feasibility of short stay after conservative breast surgery when giving the choice to women, to identify women characteristics associated to short (less than 48 hours) or conventional stay and to confront satisfaction and anxiety of the two groups. METHODS Women were able to choice the length of stay immediately after surgery. Afterwards they completed a questionnaire measuring pain, anxiety and satisfaction. Clinical data concerning surgery were also collected. RESULTS The hospital stay was short for 114 women (75.5%) and conventional for 37 women (24.5%). Length of stay was related to education level (P = 0,021), general health status (ASA score) (P = 0,003), breast pain (P = 0,001), the number of wound drains (P = 0,005), cancer (P = 0,001) and satisfaction about hospitalisation (P = 0,022). Post-surgical morbidity was similar between groups, except prolonged axillary drainage more frequent in conventional stay group. CONCLUSION Women often chose a short stay after breast conservative surgery. This procedure is feasible routinely without heavy complication. Women preference for a short stay is real and could be improved by a better organisation, which ensure the continuity of care between hospital and home, with satisfaction assessment.
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Affiliation(s)
- S Arnaud
- INSERM U379, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France.
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Schou I, Ekeberg Ø, Ruland CM, Kåresen R. Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally? Breast 2002; 11:434-41. [PMID: 14965708 DOI: 10.1054/brst.2002.0454] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2002] [Accepted: 05/14/2002] [Indexed: 11/18/2022] Open
Abstract
This study assesses the perception of the decision-making process of 25 surgeons and 194 patients (aged 21-81 years) who had newly diagnosed breast cancer and had to undergo mastectomy or breast-conserving surgery (BCS). The majority of women wanted to participate in decision-making. When it was medically possible to give a choice between BCS and mastectomy, only 59% of women received a choice. The main reason that 11% of the women went against surgeon's recommendations was fear of cancer recurrence. The most influential factors for women were the surgeon's recommendation, and fear of cancer recurrence. Medical assessment and the cosmetic result were the most influential factors for the surgeons. Female surgeons were more influenced by their assessment of the women's need for security, than male. In conclusion, not all women who are eligible for BCS receive an option. Women and surgeons emphasize influencing factors differently. The surgeon's gender was found to influence recommendation given.
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Affiliation(s)
- I Schou
- Department of General surgery, Ulleval University Hospital, Oslo, Norway.
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Isaac N, Panzarella T, Lau A, Mayers C, Kirkbride P, Tannock IF, Vallis KA. Concurrent cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy and radiotherapy for breast carcinoma: a well tolerated adjuvant regimen. Cancer 2002; 95:696-703. [PMID: 12209711 DOI: 10.1002/cncr.10744] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The current study was conducted to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy and radiotherapy (RT) for early breast carcinoma. METHODS In the current study, the authors reviewed the records of 680 consecutive breast carcinoma patients who received adjuvant CMF at the Princess Margaret Hospital between 1980-1990. Surgery was comprised of mastectomy in 64% of patients, breast conservation in 35% of patients, and was unknown in 1% of patients. Two hundred two patients received concurrent CMF/RT that was defined as an overlap in CMF and RT administration of at least 21 days. Forty-seven patients received sequential CMF/RT (defined as no overlap or an overlap of < 7 days in CMF and RT administration). Other patients received CMF alone. Adverse effects of RT were graded retrospectively using the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) system. Reasons for interruption or failure to complete RT were recorded. The magnitude of chemotherapy dose reductions and delays also were noted. RESULTS The median age of the patients was 44 years (range, 26-68 years) and 88% of the patients had lymph node-positive disease. RT was interrupted or discontinued due to side effects in 4% of patients (95% confidence interval [95% CI], 1.7-7.7%) and 0% (95% CI, 0-7.6%), respectively, of the concurrent and sequential groups (P = 0.36). The incidence of Grade 3 or Grade 4 RT toxicity was 1.5% (95% CI, 0.3-4.3%) and 2.1% (95% CI, 0.1-11.3%), respectively, for the concurrent and sequential groups (P = 0.57). The median relative dose intensity of chemotherapy for patients receiving concurrent CMF/RT, sequential CMF/RT, and CMF alone was 0.87, 0.84, and 0.85, respectively (P = 0.22). CONCLUSIONS The results of the current study demonstrate that the concurrent administration of CMF and RT is associated with a low risk of serious toxicity and is an acceptable adjuvant regimen for patients with breast carcinoma.
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Affiliation(s)
- Neil Isaac
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network and University of Toronto, Toronto, Ontario, Canada
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