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Scodari BT, Schaefer AP, Kapadia NS, Brooks GA, O'Malley AJ, Moen EL. The Association Between Oncology Outreach and Timely Treatment for Rural Patients with Breast Cancer: A Claims-Based Approach. Ann Surg Oncol 2024; 31:4349-4360. [PMID: 38538822 PMCID: PMC11176015 DOI: 10.1245/s10434-024-15195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Oncology outreach is a common strategy for increasing rural access to cancer care, where traveling oncologists commute across healthcare settings to extend specialized care. Examining the extent to which physician outreach is associated with timely treatment for rural patients is critical for informing outreach strategies. METHODS We identified a 100% fee-for-service sample of incident breast cancer patients from 2015 to 2020 Medicare claims and apportioned them into surgery and adjuvant therapy cohorts based on treatment history. We defined an outreach visit as the provision of care by a traveling oncologist at a clinic outside of their primary hospital service area. We used hierarchical logistic regression to examine the associations between patient receipt of preoperative care at an outreach visit (preoperative outreach) and > 60-day surgical delay, and patient receipt of postoperative care at an outreach visit (postoperative outreach) and > 60-day adjuvant delay. RESULTS We identified 30,337 rural-residing patients who received breast cancer surgery, of whom 4071 (13.4%) experienced surgical delay. Among surgical patients, 14,501 received adjuvant therapy, of whom 2943 (20.3%) experienced adjuvant delay. In adjusted analysis, we found that patient receipt of preoperative outreach was associated with reduced odds of surgical delay (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.61-0.91); however, we found no association between patient receipt of postoperative outreach and adjuvant delay (OR 1.04, 95% CI 0.85-1.25). CONCLUSIONS Our findings indicate that preoperative outreach is protective against surgical delay. The traveling oncologists who enable such outreach may play an integral role in catalyzing the coordination and timeliness of patient-centered care.
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Affiliation(s)
- Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Andrew P Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - A James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
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Obeng-Gyasi S, Handley D, Elsaid MI, Rahurkar S, Andersen BL, Jonnalagadda P, Chen JC, Owusu-Brackett N, Carson WE, Stover DG. Low Hospital Volume Is Associated with Higher All-Cause Mortality in Black Women with Triple Negative Breast Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01788-y. [PMID: 38038902 DOI: 10.1007/s40615-023-01788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy. METHODS Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q1 (lowest) to Q4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality. RESULTS Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q1 24.1% (95% CI: 22.8 to 25.4), Q2 21.8% (95% CI: 20.5 to 23.1), Q3 20.9% (95% CI: 19.6 to 22.1), Q4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q4 Vs. Q1, OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality. CONCLUSION Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Pallavi Jonnalagadda
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Rodríguez-Reinado C, Delgado-Parrilla A, Alguacil J. Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12728. [PMID: 36232027 PMCID: PMC9566388 DOI: 10.3390/ijerph191912728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease.
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Affiliation(s)
- Carmen Rodríguez-Reinado
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Ana Delgado-Parrilla
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Juan Alguacil
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), University of Huelva, 21071 Huelva, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Effects of surgeon volume and hospital volume on clinical outcomes of breast cancer patients. ARCHIVE OF ONCOLOGY 2022. [DOI: 10.2298/aoo210720006p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cancer presents significant hurdle in the goal to increase the life
expectancy of the world population. In 2020 breast cancer has become the
leading cause of global cancer in the female population, ahead of lung
cancer. Over the past half century, approach to the treatment of breast
cancer has changed dramatically that led to improvement of survival rates
and quality of life of patients. In particular, the changes affected the
surgical treatment of breast cancer. The modern tactics of treating breast
cancer patients has become more complex and requires a multidisciplinary
approach led by an oncological surgeon. It requires the availability of
specialized material and equipment in medical institutions and practical
skills of surgeons that provide medical care to breast cancer patients.
However, breast cancer patients may not receive the entire range of modern
treatment options, due to limited capabilities of medical institution and/or
surgeon that leads to deterioration in duration and quality of life of
patients. The quality of medical care for breast cancer patients is directly
proportional to the number of cases performed annually at a medical
institution (hospital volume) or by a surgeon (surgeon volume). The results
of this study can serve as a basis for further investigations of the
relationship between the surgeon and hospital volume and other factors
affecting the quality and diversity of medical care for breast cancer
patients.
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The Association of Overall Annual Hospital Volume and Perioperative Outcomes following Free Flap Breast Reconstruction. Plast Reconstr Surg 2021; 147:196e-206e. [PMID: 33565821 DOI: 10.1097/prs.0000000000007549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital volume has been correlated with improved outcomes in oncologic care and complex surgical procedures. The authors sought to determine the relationship between overall annual hospital volume and perioperative outcomes following free flap breast reconstruction. METHODS Free flap breast reconstruction patients (n = 7991) were identified at 1907 centers using the Healthcare Cost and Utilization Project National Inpatient Sample database. Logistic regression characterized the association of hospital volume (total discharges per year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low- versus high-volume hospitals based on identified threshold volumes, and the association with the incidence of complications was estimated. RESULTS Initially, restricted cubic spline analysis suggested potential threshold volumes of 13,018 (95 percent CI, 7468 to 14,512) and 7091 (95 percent CI, 5396 to 9918) discharges per year, at which the risk for developing systemic and microsurgical complications may change, respectively. However, further patient-level evaluation of treatment at low- versus high-volume hospitals demonstrated that hospital volume did not predict the risk of developing perioperative systemic (OR, 1.28; 95 percent CI, 0.75 to 2.18; p = 0.36) or microsurgical complications (OR, 1.06; 95 percent CI, 0.78 to 1.44; p = 0.73). CONCLUSIONS Perioperative complications after free flap breast reconstruction did not differ between patients treated at low- versus high-volume hospitals after in-depth multiprong analysis. Patient outcomes are more likely associated with surgeon and programmatic experience. Overall annual hospital volume should not serve as a proxy for high-quality breast free flap care. . CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Do hospital type or caseload make a difference in chemotherapy treatment patterns for early breast cancer? Results from 104 German institutions, 2008-2017. Breast 2021; 58:63-71. [PMID: 33933924 PMCID: PMC8102997 DOI: 10.1016/j.breast.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Over the past decade, chemotherapy has been used more selectively in early breast cancer (EBC) due to better risk stratification. Neoadjuvant chemotherapy (NACT) has evolved to the primary treatment option. The type and size of hospitals is known to have a substantial influence on the kinds of treatment they provide, and therefore on patient outcomes (e.g. rates for pathological complete response, pCR), but it is not yet known how this has affected delivery of chemotherapy for EBC in Germany. METHODS This study analyzed chemotherapy use and pCR rates after NACT for EBC patients treated at 104 German institutions 2008-2017. Institutions were separated into associated hospital type (university hospital; teaching hospital; community hospital) and annual caseload (≤100; 101-250; >250 cases/year). RESULTS Overall, 124,084 patients were included, of whom 11.6% were treated at university hospitals, 63.1% at teaching hospitals, and 25.3% at community hospitals. In total, 46,274 (37.3%) received chemotherapy, of whom 44,765 had information available about systemic treatment and surgery. From 2008 to 2017, chemotherapy use declined from 48.3% to 36.4% for university hospitals, from 40.7% to 30.3% for teaching hospitals, and from 42.4% to 33.7% for community hospitals. Furthermore, the proportion of NACT increased the most in university hospitals (from 32.0% to 68.1%); whereas, the rate of pCR (defined as ypT0 ypN0) increased irrespective of institutional type. Analyses regarding annual caseload did not show any differences. CONCLUSIONS The results from this large, nationwide cohort reflect a more selective use of chemotherapy in Germany, irrespective of institutional type or case load.
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A national audit of radiology practice in cancer multidisciplinary team meetings. Clin Radiol 2020; 75:640.e17-640.e27. [DOI: 10.1016/j.crad.2020.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/18/2020] [Indexed: 11/24/2022]
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8
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Vanni G, Materazzo M, Santori F, Pellicciaro M, Costesta M, Orsaria P, Cattadori F, Pistolese CA, Perretta T, Chiocchi M, Meucci R, Lamacchia F, Assogna M, Caspi J, Granai AV, DE Majo A, Chiaravalloti A, D'Angelillo MR, Barbarino R, Ingallinella S, Morando L, Dalli S, Portarena I, Altomare V, Tazzioli G, Buonomo OC. The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey. In Vivo 2020; 34:1685-1694. [PMID: 32503830 DOI: 10.21873/invivo.11962] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). PATIENTS AND METHODS In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. RESULTS A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. CONCLUSION Working in a COVID-19-hospital represents a factor that negatively affects psychosocial well-being. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Costesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Francesca Cattadori
- UO Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Massimo Assogna
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Adriano DE Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Maria Rolando D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Barbarino
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ljuba Morando
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Stefania Dalli
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Giovanni Tazzioli
- Oncologic Breast Surgery Unit, Azienda Ospedaliero-Universitaria Policlinico Hospital of Modena, Modena, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Biganzoli L, Cardoso F, Beishon M, Cameron D, Cataliotti L, Coles CE, Delgado Bolton RC, Trill MD, Erdem S, Fjell M, Geiss R, Goossens M, Kuhl C, Marotti L, Naredi P, Oberst S, Palussière J, Ponti A, Rosselli Del Turco M, Rubio IT, Sapino A, Senkus-Konefka E, Skelin M, Sousa B, Saarto T, Costa A, Poortmans P. The requirements of a specialist breast centre. Breast 2020; 51:65-84. [PMID: 32217457 PMCID: PMC7375681 DOI: 10.1016/j.breast.2020.02.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Laura Biganzoli
- European Society of Breast Cancer Specialists (EUSOMA); Breast Centre, AUSL Toscana Centro, Prato, Italy.
| | - Fatima Cardoso
- European Society of Medical Oncology (ESMO); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - David Cameron
- European Cancer Concord (ECC); University of Edinburgh Cancer Centre, IGMM, Western General Hospital, Edinburgh, UK
| | - Luigi Cataliotti
- European Society of Breast Cancer Specialists (EUSOMA), Senonetwork Italia and Breast Centres Certification, Florence, Italy
| | - Charlotte E Coles
- European Society for Radiotherapy and Oncology (ESTRO); University of Cambridge, Cambridge, UK
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Donna, Milan, Italy
| | - Maria Fjell
- European Oncology Nursing Society (EONS); Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Romain Geiss
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Hôpital René Huguenin - Institut Curie, St. Cloud, France
| | - Mathijs Goossens
- European Cancer League (ECL); Centre for Cancer Detection (CvKO), Brussels, Belgium
| | - Christiane Kuhl
- European Society of Radiology (ESR); Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Jean Palussière
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Department of Imaging, Institut Bergonié, Bordeaux, France
| | - Antonio Ponti
- European Society of Breast Cancer Specialists (EUSOMA), Centre for Epidemiology and Prevention in Oncology (CPO) Piemonte, AOU Citta' Della Salute e Della Scienza, Turin, Italy
| | | | - Isabel T Rubio
- European Society of Surgical Oncology (ESSO); Breast Surgical Oncology, Clinica Universidad de Navarra Madrid, Spain
| | - Anna Sapino
- European Society of Pathology (ESP); Department of Medical Sciences, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Elzbieta Senkus-Konefka
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Marko Skelin
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Berta Sousa
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Tiina Saarto
- Flims Alumni Club (FAC); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - Philip Poortmans
- Iridium Kankernetwerk, University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Wilrijk-Antwerp, Belgium
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Huang YH, Lai HC, Wu TS, Wu KL, Wu ZF. Something more than tramadol use in breast cancer surgery. Comment on Br J Anaesth 2019; 123: 865-76. Br J Anaesth 2020; 124:e193-e194. [PMID: 31952650 DOI: 10.1016/j.bja.2019.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | | | | | | | - Zhi-Fu Wu
- Taipei, Taiwan, ROC; Tainan City, Taiwan, ROC.
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11
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Park KU, Selby L, Chen XP, Cochran A, Harzman A, Shen C, Gregory ME. Development of Residents' Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey. J Surg Res 2020; 251:275-280. [PMID: 32197183 DOI: 10.1016/j.jss.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/23/2020] [Accepted: 02/16/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Treating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. METHODS Based on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. RESULTS Response rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. CONCLUSIONS We created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.
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Affiliation(s)
- Ko Un Park
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
| | - Luke Selby
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaodong Phoenix Chen
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amalia Cochran
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alan Harzman
- Department of Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
| | - Chengli Shen
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Megan E Gregory
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, Ohio
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12
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Abstract
PURPOSE OF REVIEW The goals of surgery for breast cancer have remained the same over the years, to eliminate breast cancer from the breast with the least degree of deformity. With the current expectation of long-term survival after breast cancer treatment, more attention has turned to the cosmetic result of the surgical treatment. Whether lumpectomy or mastectomy, the need for aesthetic improvement was recognized by surgeons both in and outside the USA. RECENT FINDINGS Oncoplastic surgery combines the skills of the cancer surgeon with those of the plastic surgeon. Sometimes, this means a team approach with a breast surgeon and a plastic surgeon both performing their mutual skills for the patient. Other times, the properly trained breast surgeon may perform some of the plastic techniques at the time of cancer surgery. Breast surgeons are rapidly gaining the ability to improve the post-cancer treatment appearance. To simplify the classification of oncoplastic techniques, we have used lower level, upper level, and highest level. The assignment of techniques to levels is based on both the technique and the surgeon's training and experience. Much data has accumulated demonstrating the safety and efficacy of the "aesthetic cancer cure." We describe the development of oncoplastic surgery, the techniques available, matching the right candidate with the right technique, and some comments about the future. It is clear from both clinical benefit and patient satisfaction that oncoplastic breast cancer procedures are here to stay. Plastic surgeons will likely focus on the upper- and highest-level procedures while breast/general surgeons will learn lower-level procedures and some of upper-level procedures as needed by their locale. Opportunities to educate breast/general surgeons in these techniques will continue to increase over the next several years. Formal education in oncoplastic surgery during breast fellowships will be necessary to catch up with the rest of the surgical world outside the USA.
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Affiliation(s)
- Cary S Kaufman
- Department of Surgery, University of Washington, Bellingham Regional Breast Center, 2075 Barkley Blvd., Suite 250, Bellingham, Washington, 98226, USA.
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Huang YH, Lee MS, Lou YS, Lai HC, Yu JC, Lu CH, Wong CS, Wu ZF. Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery. PLoS One 2019; 14:e0224728. [PMID: 31697743 PMCID: PMC6837387 DOI: 10.1371/journal.pone.0224728] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women and several perioperative factors may account for tumor recurrence and metastasis. The anesthetic agents employed during cancer surgery might play a crucial role in cancer cell survival and patient outcomes. We conducted a retrospective cohort study to investigate the relationship between the type of anesthesia and overall survival in patients who underwent breast cancer surgery performed by one experienced surgeon. METHODS All patients who underwent breast cancer surgery by an experienced surgeon between January 2006 and December 2010 were included in this study. Patients were separated into two groups according to the use of desflurane or propofol anesthesia during surgery. Locoregional recurrence and overall survival rates were assessed for the two groups (desflurane or propofol anesthesia). Univariable and multivariable Cox regression models and propensity score matching analyses were used to compare the hazard ratios for death and adjust for potential confounders (age, body mass index, American Society of Anesthesiologists physical status classification, TNM stage, neoadjuvant chemotherapy, Charlson Comorbidity Index, anesthesiologists, and functional status). RESULTS Of the 976 breast cancer patients, 632 patients underwent breast cancer surgery with desflurane anesthesia, while 344 received propofol anesthesia. After propensity scoring, 592 patients remained in the desflurane group and 296 patients in the propofol group. The mortality rate was similar in the desflurane (38 deaths, 4%) and propofol (22 deaths, 4%; p = 0.812) groups in 5-year follow-up. The crude hazard ratio (HR) for all patients was 1.13 (95% confidence interval [CI] 0.67-1.92, p = 0.646). No significant difference in the locoregional recurrence or overall 5-year survival rates were found after breast surgery using desflurane or propofol anesthesia (p = 0.454). Propensity score-matched analyses demonstrated similar outcomes in both groups. Patients who received propofol anesthesia had a higher mortality rate than those who received desflurane anesthesia in the matched groups (7% vs 6%, respectively) without significant difference (p = 0.561). In the propensity score-matched analyses, univariable analysis showed an insignificant finding (HR = 1.23, 95% CI 0.72-2.11, p = 0.449). After adjustment for the time since the earliest included patient, the HR remained insignificant (HR = 1.23, 95% CI 0.70-2.16, p = 0.475). CONCLUSION In our non-randomized retrospective analysis, neither propofol nor desflurane anesthesia for breast cancer surgery by an experienced surgeon can affect patient prognosis and survival. The influence of propofol anesthesia on breast cancer outcome requires further investigation.
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Affiliation(s)
- Yi-Hsuan Huang
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Sheng Lou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chueng-He Lu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Shung Wong
- Division of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan, Republic of China
- * E-mail:
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14
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Variability in breast cancer surgery training across Europe: An ESSO-EUSOMA international survey. Eur J Surg Oncol 2019; 45:567-572. [DOI: 10.1016/j.ejso.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022] Open
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Ho-Huynh A, Tran A, Bray G, Abbot S, Elston T, Gunnarsson R, de Costa A. Factors influencing breast cancer outcomes in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13038. [PMID: 30919536 DOI: 10.1111/ecc.13038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION CRD42017072857.
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Affiliation(s)
- Albert Ho-Huynh
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Tran
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Gerard Bray
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Samuel Abbot
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Ronny Gunnarsson
- Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Alan de Costa
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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16
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Montagna G, Anderson D, Bochenek-Cibor J, Bozovic-Spasojevic I, Campos C, Cavallero S, Durutovic I, Gomez Cuadra MO, Irfan T, Joly L, Kassem L, Kolben TM, Machacek M, Mir Khan B, Nagvekar M, Pellegrino B, Pogoda K, Câmara GR, Ferreira PS, Seferi M, Talibova N, Van den Rul N, Vettus E, Rocco N. How to become a breast cancer specialist in 2018: The point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2). Breast 2019; 43:18-21. [PMID: 30388502 DOI: 10.1016/j.breast.2018.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022] Open
Abstract
Breast cancer (BC) is the most frequent cancer in women and the leading cause of cancer death in females worldwide. Rapid research advancements add to the complexity of treatment options for this disease. It is known that the quality of patients' care is deeply affected by healthcare professionals following these advancements. There is a growing need for academic education to increase clinical knowledge and skills of physicians treating BC patients. The certificate of Competence in Breast Cancer Program (CCB) is a Certificate in Advanced Studies (CAS) organized by the European School of Oncology in cooperation with Ulm University (Germany), which focuses on both the clinical and scientific competence required for improving quality in the management of BC patients. This paper describes the experience of the second CCB cohort (CCB2), which brought together 24 physicians from four continents who shared the common will to improve their competence and skills in BC treatment.
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Affiliation(s)
- Giacomo Montagna
- Breast Center, University Hospital of Basel, Basel, Switzerland; Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland.
| | | | | | | | | | - Sandro Cavallero
- Department of Oncology, Hospital Adventista de Belem, Belem, Brazil
| | - Ivana Durutovic
- Clinic for Oncology and Radiotherapy, Clinical Center of Montenegro, Montenegro
| | | | - Tazia Irfan
- Department of Medical Oncology, Royal Marsden Hospital, London, England, United Kingdom
| | - Laetita Joly
- Department of Oncology, Hospital Center of Argenteuil, Argenteuil, France
| | - Loay Kassem
- Department of Oncology, Cairo University Hospital, Cairo, Egypt
| | - Theresa M Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Martina Machacek
- Department of Gynecology and Obstetrics, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Benazir Mir Khan
- Department of Radiation Oncology, Aga Khan University Hospital, Pakistan
| | - Mayur Nagvekar
- Department of Surgery, Nagvekar Hospital and Charitable Trust, India
| | - Benedetta Pellegrino
- Oncology Department, University Hospital of Parma, Parma, Italy; Experimental Therapeutic Group, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska- Curie Institute - Oncology Center, Warsaw, Poland
| | - Gabriela Rodrigues Câmara
- Department of Oncology, Hospital Divino Espirito Santo de Ponta Delgada, S. Miguel, Azores, Portugal
| | | | - Melsi Seferi
- Breast Center, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Baden-Württemberg, Germany
| | | | | | - Elen Vettus
- Department of Oncology, North Estonia Medical Centre, Tallinn, Estonia; Department of Oncology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "FedericoII", Naples, Italy
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17
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Abstract
OBJECTIVE The aim of this study was to determine whether hospital volume was associated with mortality in breast cancer, and what thresholds of case volume impacted survival. BACKGROUND Prior literature has demonstrated improved survival with treatment at high volume centers among less common cancers requiring technically complex surgery. METHODS All adults (18 to 90 years) with stages 0-III unilateral breast cancer diagnosed from 2004 to 2012 were identified from the American College of Surgeons National Cancer Data Base (NCDB). A multivariable Cox proportional hazards model with restricted cubic splines was used to examine the association of annual hospital volume and overall survival, after adjusting for measured covariates. Intergroup comparisons of patient and treatment characteristics were conducted with X and analysis of variance (ANOVA). The log-rank test was used to test survival differences between groups. A multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) associated with each volume group. RESULTS One million sixty-four thousand two hundred and fifty-one patients met inclusion criteria. The median age of the sample was 60 (interquartile range 50 to 70). Hospitals were categorized into 3 groups using restricted cubic spline analysis: low-volume (<148 cases/year), moderate-volume (148 to 298 cases/year), and high-volume (>298 cases/year). Treatment at high volume centers was associated with an 11% reduction in overall mortality for all patients (HR 0.89); those with stage 0-I, ER+/PR+ or ER+/PR- breast cancers derived the greatest benefit. CONCLUSIONS Treatment at high volume centers is associated with improved survival for breast cancer patients regardless of stage. High case volume could serve as a proxy for the institutional infrastructure required to deliver complex multidisciplinary breast cancer treatment.
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18
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Westley T, Syrowatka A, Henault D, Rho YS, Khazoom F, Chang SL, Tamblyn R, Mayo N, Meguerditchian AN. Patterns and predictors of emergency department visits among older patients after breast cancer surgery: A population-based cohort study. J Geriatr Oncol 2018; 9:204-213. [DOI: 10.1016/j.jgo.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/04/2017] [Accepted: 10/27/2017] [Indexed: 12/29/2022]
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19
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Simpson JS. Reflections: Rethinking the Meaning of Competence. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:238-241. [PMID: 27193413 DOI: 10.1007/s13187-016-1049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jory S Simpson
- Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
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20
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Yen TWF, Laud PW, Pezzin LE, McGinley EL, Wozniak E, Sparapani R, Nattinger AB. Prevalence and Consequences of Axillary Lymph Node Dissection in the Era of Sentinel Lymph Node Biopsy for Breast Cancer. Med Care 2018; 56:78-84. [PMID: 29087982 PMCID: PMC5725235 DOI: 10.1097/mlr.0000000000000832] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite clear guidelines for its use and wide adoption, no population-based study has examined the extent to which patients with early stage breast cancer are benefiting from sentinel lymph node biopsy (SLNB) by being spared a potentially avoidable axillary lymph node dissection (ALND) and its associated morbidity. OBJECTIVE Examine variation in type of axillary surgery performed by surgeon volume; investigate the extent and consequences of potentially avoidable ALND. RESEARCH DESIGN/SUBJECTS Observational study of older women with pathologically node-negative stage I-II invasive breast cancer who underwent surgery in a SEER state in 2008-2009. MEASURES Surgeon annual volume of breast cancer cases and type of axillary surgery were determined by Medicare claims. An estimated probability of excess lymphedema due to ALND was calculated. RESULTS Among 7686 pathologically node-negative women, 49% underwent ALND (either initially or after SLNB) and 25% were operated on by low-volume surgeons. Even after adjusting for demographic and tumor characteristics, women treated by higher volume surgeons were less likely to undergo ALND [medium volume: odds ratio, 0.69 (95% confidence interval, 0.51-0.82); high volume: odds ratio, 0.59 (95% confidence interval, 0.45-0.76)]. Potentially avoidable ALND cases were estimated to represent 21% of all expected lymphedema cases. CONCLUSIONS In this pathologically node-negative population-based breast cancer cohort, only half underwent solely SLNB. Patients treated by low-volume surgeons were more likely to undergo ALND. Resources and guidelines on the appropriate training and competency of surgeons to assure the optimal performance of SLNB should be considered to decrease rates of potentially avoidable ALND and lymphedema.
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Affiliation(s)
- Tina W F Yen
- Department of Surgery
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
| | - Purushottam W Laud
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics
| | - Liliana E Pezzin
- Division of Biostatistics
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine
| | - Emily L McGinley
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
| | - Erica Wozniak
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
| | - Rodney Sparapani
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics
| | - Ann B Nattinger
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine
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21
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Absence of an anticipated racial disparity in interval breast cancer within a large health care organization. Ann Epidemiol 2017; 27:654-658. [PMID: 28964641 DOI: 10.1016/j.annepidem.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE Compared to non-Latina (nL) white women, nL black women are diagnosed with more aggressive breast cancers, which in turn should be more likely to go undetected on screening mammography and subsequently arise as interval breast cancer (IBC). We sought to estimate the extent of an anticipated racial disparity in IBC within a single, large health care organization. METHODS The present analysis focuses on 4357 breast cancers diagnosed between 2001 and 2012 and within 18 months of a screening mammogram (N = 714,218). We used logistic regression with model-based standardization (predictive margins) to estimate adjusted prevalence differences corresponding to a racial disparity in IBC. RESULTS Overall, prevalence of IBC within 18 months was 20.7%. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity (percentage point disparity = -2.1, 95% confidence interval: -4.7, 2.6). However, when controlling for facility characteristics, including proportion of nL black patients, the model coefficient for the IBC disparity reversed sign and changed substantially (P < .0001) and a racial disparity emerged (percentage point disparity = +5.1, 95% confidence interval: -0.3, 9.9). CONCLUSIONS The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC. Possible explanations are discussed.
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Fung F, Cornacchi SD, Vanniyasingam T, Dao D, Thabane L, Simunovic M, Hodgson N, O'Brien MA, Reid S, Heller B, Lovrics PJ. Predictors of 5-year local, regional, and distant recurrent events in a population-based cohort of breast cancer patients. Am J Surg 2017; 213:418-425. [DOI: 10.1016/j.amjsurg.2016.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
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Cardoso F, Cataliotti L, Costa A, Knox S, Marotti L, Rutgers E, Beishon M. European Breast Cancer Conference manifesto on breast centres/units. Eur J Cancer 2017; 72:244-250. [PMID: 28064097 DOI: 10.1016/j.ejca.2016.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
MANIFESTO-CALL TO ACTION.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal.
| | - Luigi Cataliotti
- Breast Centres Certification and Senonetwork Italia Onlus, Italy
| | | | - Susan Knox
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Lorenza Marotti
- EUSOMA - European Society of Breast Cancer Specialists, Italy
| | - Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
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Simpson JS, Scheer AS. A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick's Evaluation Model. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:466-471. [PMID: 26058681 DOI: 10.1007/s13187-015-0866-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It has been 10 years since the first class of Society of Surgical Oncology (SSO) fellowship trained Breast Surgical Oncologist entered practice. To date, there has been no publications examining the effectiveness of these training programs that are today throughout North America and Europe. This evaluative review examines the effectiveness of these fellowship training programs through the lens of the Kirkpatrick Evaluation Model. An extensive review of the literature was performed, and articles were categorized to capture how fellows are reacting to the program, what they are learning, and how the program is effecting their career path and impacting their patients. We can conclude that there is both direct and indirect evidence to support the effectiveness of this training program, but there is a paucity of direct evidence as one progresses from a level 1 Kirkpatrick analysis to a level 4. This review sets the framework for program evaluation in surgical fellowships and should encourage stakeholders to constantly evaluate the impact their program is having on trainees and oncology patients.
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Affiliation(s)
- Jory S Simpson
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | - A S Scheer
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
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25
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Abstract
Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Nevada Central Cancer Registry data was linked with the National Death Index and the Social Security Administration Masterfile. Overall 5-year age-adjusted cause-specific survival, survival stratified by race/ethnicity, and stage-specific survival stratified by region of Nevada were calculated. Adjusted hazard ratios were computed with Cox proportional hazards regression. 11,111 cases of breast cancer were diagnosed from 2003 to 2010. Overall 5-year breast cancer survival in Nevada was 84.4 %, significantly lower than the US, at 89.2 %. Black and Filipina women had a higher risk of death than white women. Poor survival in the racially and ethnically diverse Las Vegas metropolitan area, with a large foreign-born population, drives Nevada's low overall survival. System-wide changes are recommended to reduce the racial/ethnic disparities seen for black and Filipina women and improve outcomes for all.
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Loveland-Jones C, Lin H, Shen Y, Bedrosian I, Shaitelman S, Kuerer H, Woodward W, Ueno N, Valero V, Babiera G. Disparities in the Use of Postmastectomy Radiation Therapy for Inflammatory Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 95:1218-25. [PMID: 27209502 DOI: 10.1016/j.ijrobp.2016.02.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Although radiation therapy improves locoregional control and survival for inflammatory breast cancer (IBC), it is underused in this population. The purpose of this study was to identify variables associated with the underuse of postmastectomy radiation therapy (PMRT) for IBC. METHODS AND MATERIALS Using the 1998 to 2011 National Cancer Data Base, we identified 8273 women who underwent mastectomy for nonmetastatic IBC. We used logistic regression modeling to determine the demographic, tumor, and treatment variables associated with the underuse of PMRT. RESULTS Although the use of PMRT increased over time, a total of 30.3% of our cohort did not receive PMRT. On multivariate analysis, variables associated with the underuse of PMRT for IBC included the following (all P<.05): Medicare insurance (odds ratio [OR] = 0.70), annual income <$34,999 (<$30,000: OR=0.79; $30,000-$34,999: OR=0.82), cN2 and cN0 disease (cN2: OR=0.71; cN0: OR=0.63), failure to receive chemotherapy and hormone therapy (chemotherapy: OR=0.15; hormone therapy: OR=0.35), treatment at lower-volume centers (OR=0.83), and treatment in the South and West (South: OR=0.73; West: OR=0.80). Greater distance between patient's residence and radiation facility was also associated with the underuse of PMRT (P=.0001). CONCLUSIONS Although the use of PMRT for IBC has increased over time, it continues to be underused. Disparities related to a variety of variables impact which IBC patients receive PMRT. A concerted effort must be made to address these disparities in order to optimize the outcomes for IBC.
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Affiliation(s)
| | - Heather Lin
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Henry Kuerer
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Wendy Woodward
- University of Texas, MD Anderson Cancer Center, Houston, Texas; MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas
| | - Naoto Ueno
- University of Texas, MD Anderson Cancer Center, Houston, Texas; MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas
| | - Vicente Valero
- University of Texas, MD Anderson Cancer Center, Houston, Texas; MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas
| | - Gildy Babiera
- University of Texas, MD Anderson Cancer Center, Houston, Texas; MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, Texas.
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Chin-Yee NJ, Yan AT, Kumachev A, Ko D, Earle C, Tomlinson G, Trudeau ME, Krahn M, Krzyzanowska M, Pal R, Brezden-Masley C, Gavura S, Lien K, Chan K. Association of hospital and physician case volumes with cardiac monitoring and cardiotoxicity during adjuvant trastuzumab treatment for breast cancer: a retrospective cohort study. CMAJ Open 2016; 4:E66-72. [PMID: 27280116 PMCID: PMC4866921 DOI: 10.9778/cmajo.20150033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Adjuvant trastuzumab is the standard of care for patients with HER2 overexpressing breast cancer, but use of trastuzumab may lead to cardiotoxicity. Our goal was to evaluate the relationship between hospital and physician case volume and cardiac outcomes in this population. METHODS In this retrospective cohort study, we identified all female patients in Ontario with a breast cancer diagnosis in 2003-2009 who underwent treatment with trastuzumab through a provincial drug-funding program and linked these patients to administrative databases to ascertain patient demographics, treating hospital and physician characteristics, admissions to hospital, cardiac risk factors, cardiac imaging and comorbidities. Insufficient cardiac monitoring was defined as per the Canadian Trastuzumab Working Group guideline. Cardiotoxicity was defined as receiving fewer than 16 of 18 doses of trastuzumab because of heart failure admission, heart failure diagnosis or discontinuation of the drug after cardiac imaging. We constructed hierarchical multivariable logistic regression models to evaluate the effect of annual hospital volume, cumulative physician volume and treatment period on cardiac monitoring and cardiotoxicity. RESULTS Of 3777 women treated by 214 oncologists at 68 hospitals, 918 (24.3%) had insufficient cardiac monitoring and cardiotoxicity developed in 640 (16.9%). Cardiotoxicity occurred in 389 (42.4%) and 251 (8.8%) patients in the insufficient- and sufficient-monitoring groups, respectively. Higher annual hospital and cumulative physician volumes, and more recent calendar period, were all independent predictors for decreased cardiotoxicity. Adjustment for rates of cardiac monitoring annulled the relationships between case volume and cardiotoxicity. INTERPRETATION Greater hospital and physician case volumes are associated with reduced rates of trastuzumab-related cardiotoxicity, most likely because of better cardiac monitoring at higher volume centres.
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Affiliation(s)
- Nicolas J Chin-Yee
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Andrew T Yan
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Alexander Kumachev
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Dennis Ko
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Craig Earle
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - George Tomlinson
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Maureen E Trudeau
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Murray Krahn
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Monika Krzyzanowska
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Raveen Pal
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Christine Brezden-Masley
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Scott Gavura
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Kelly Lien
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
| | - Kelvin Chan
- University of Toronto (Chin-Yee, Yan, Kumachev, Ko, Tomlinson, Trudeau, Krahn, Brezden-Masley, Chan); St. Michael's Hospital (Yan, Brezden-Masley); Institute for Clinical and Evaluative Sciences (Ko, Earle); Sunnybrook Health Sciences Centre (Ko, Earle, Trudeau, Chan); University Health Network (Tomlinson, Krzyzanowska), Toronto, Ont.; Kingston General Hospital (Pal), Kingston; Cancer Care Ontario (Gavura); Canadian Centre for Applied Research in Cancer Control (Chan), Toronto, Ont
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Conway RG, Bartlett EK, Hoffman RL, Czerniecki BJ, Karakousis GC, Kelz RR. Residents' Experience in Breast Cancer Care. JOURNAL OF SURGICAL EDUCATION 2015; 72:1233-1239. [PMID: 26119094 DOI: 10.1016/j.jsurg.2015.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE General surgeons commonly treat breast cancer (BC), hence necessitating adequate training during residency. We examined surgery residents' exposure to these conditions across postgraduate years (PGYs) to assess the proximity of involvement to commencement. STUDY DESIGN We examined the BC operative profile by PGY using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (ACS NSQIP PUF, 2008-2011). Operations were classified using the Surgical Council on Resident Education curriculum complexity categories. Univariate analysis was performed using chi-square, Fisher exact, analysis of variance, and Kruskal-Wallis tests, as appropriate. RESULTS Of 58,413 BC operations, 23,996 involved PGY1 to PGY5 residents. A Surgical Council on Resident Education complexity was assigned to 97.7% of operations studied (n = 23,432). PGY was inversely proportional to the number of operations performed. PGY1 to PGY3 residents covered most essential-common operations (PGY1-3, 72% vs PGY4-5, 28%; p < 0.001). PGY1 and PGY2 residents covered more than half of the complex operations (PGY1-2, 55% [n = 359] vs PGY3-5, 45% [n = 288]; p = 0.033). CONCLUSIONS Although junior residents perform most of the BC cases in surgical residency, residents do participate in operations for BC across the continuum of the training years. Program directors should consider trainees' career aspirations to ensure adequate exposure to the operative and nonoperative management of this common disease before the transition to independent practice.
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Affiliation(s)
- R Gregory Conway
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edmund K Bartlett
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca L Hoffman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Czerniecki
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Kong AL, Pezzin LE, Nattinger AB. Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis. Breast Cancer Res Treat 2015; 153:689-98. [DOI: 10.1007/s10549-015-3561-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
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Lathan CS. Lung cancer care: the impact of facilities and area measures. Transl Lung Cancer Res 2015; 4:385-91. [PMID: 26380179 DOI: 10.3978/j.issn.2218-6751.2015.07.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 11/14/2022]
Abstract
Lung cancer is the leading cause of cancer related mortality in the US, and while treatment disparities by race and class have been well described in the literature, the impact of social determinates of health, and specific characteristics of the treatment centers have been less well characterized. As the treatment of lung cancer relies more upon a precision and personalized medicine approach, where patients obtain treatment has an impact on outcomes and could be a major factor in treatment disparities. The purpose of this manuscript is to discuss the manner in which lung cancer care can be impacted by poor access to high quality treatment centers, and how the built environment can be a mitigating factor in the pursuit of treatment equity.
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Affiliation(s)
- Christopher S Lathan
- McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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Siesling S, Tjan-Heijnen VCG, de Roos M, Snel Y, van Dalen T, Wouters MW, Struikmans H, van der Hoeven JJM, Maduro JH, Visser O. Impact of hospital volume on breast cancer outcome: a population-based study in the Netherlands. Breast Cancer Res Treat 2014; 147:177-84. [PMID: 25106659 DOI: 10.1007/s10549-014-3075-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/21/2014] [Indexed: 12/01/2022]
Abstract
For low-volume tumours, high surgical hospital volume is associated with better survival. For high-volume tumours like breast cancer, this association is unclear. The aim of this study is to determine to what extent the yearly surgical hospital breast cancer volume is associated with overall survival. All patients, diagnosed with primary invasive non-metastatic breast cancer in the period 2001-2005, were selected from the Netherlands Cancer Registry. Hospitals were grouped by their annual volume of surgery for invasive breast cancer. Cox proportional hazard models were used including patient and tumour characteristics as covariates. Follow-up was completed until the 1st of February 2013. Primary endpoint was 10-year overall survival rate. In total, 58,982 patients with invasive non-metastatic breast cancer were diagnosed during the period 2001-2005. Hospitals were grouped by their (mean) annual surgical volume: <75 (n = 19), 75-99 (n = 30), 100-149 (n = 29), 150-199 (n = 9) and ≥200 (n = 14). The 10-year observed survival rates were 77, 81, 80, 82 and 82 %, respectively. After case-mix adjustment, patients in low-volume hospitals had a HR of 1.09 (<75 vs. ≥200; 95 % CI 1.03-1.15). Survival was significantly higher for lobular carcinoma and for diagnosis in the most recent year (2005). Being a male, having a higher age at diagnosis, a higher tumour grade, a larger tumour size, a higher number of positive lymph nodes, an earlier year of diagnosis and a lower SES resulted in a reduced survival and influenced death, all to a larger extent than surgical volume did. In the Netherlands, surgical hospital volume influences 10-year overall survival only marginally and far less than patient and tumour characteristics. No difference in survival was revealed for invasive non-metastatic breast cancer patients in hospitals with 75-99 operations per year compared with hospitals with over 200 operations per year.
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Affiliation(s)
- Sabine Siesling
- Dept of Registration and Research, Comprehensive Cancer Centre the Netherlands, 19097, 3501 DB, Utrecht, The Netherlands,
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Yen TWF, Laud PW, Sparapani RA, Nattinger AB. Surgeon specialization and use of sentinel lymph node biopsy for breast cancer. JAMA Surg 2014; 149:185-92. [PMID: 24369337 DOI: 10.1001/jamasurg.2013.4350] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically node-negative breast cancer. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to these patients, this practice pattern could lead to unnecessary axillary lymph node dissections and lymphedema. OBJECTIVE To explore potential measures of surgical expertise (including a novel objective specialization measure: percentage of a surgeon's operations performed for breast cancer determined from Medicare claims) on the use of SLNB for invasive breast cancer. DESIGN, SETTING, AND POPULATION A population-based prospective cohort study was conducted in California, Florida, and Illinois. Participants included elderly (65-89 years) women identified from Medicare claims as having had incident invasive breast cancer surgery in 2003. Patient, tumor, treatment, and surgeon characteristics were examined. MAIN OUTCOME AND MEASURE Type of axillary surgery performed. RESULTS Of 1703 women who received treatment by 863 surgeons, 56.4% underwent an initial SLNB, 37.2% initial axillary lymph node dissection, and 6.3% no axillary surgery. The median annual surgeon Medicare volume of breast cancer cases was 6.0 (range, 1.5-57.0); the median surgeon percentage of breast cancer cases was 4.5% (range, 0.4%-100.0%). After multivariable adjustment of patient and surgeon factors, women operated on by surgeons with higher volumes and percentages of breast cancer cases had a higher likelihood of undergoing SLNB. Specifically, women were most likely to undergo SLNB if the operation was performed by high-volume surgeons (regardless of percentage) or by lower-volume surgeons with a high percentage of breast cancer cases. In addition, membership in the American Society of Breast Surgeons (odds ratio, 1.98; 95% CI, 1.51-2.60) and Society of Surgical Oncology (1.59; 1.09-2.30) were independent predictors of women undergoing an initial SLNB. CONCLUSIONS AND RELEVANCE Patients who receive treatment from surgeons with more experience with and focus on breast cancer are significantly more likely to undergo SLNB, highlighting the importance of receiving initial treatment by specialized providers. Factors relating to specialization in a particular area, including our novel surgeon percentage measure, require further investigation as potential indicators of quality of care.
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Affiliation(s)
- Tina W F Yen
- Division of Surgical Oncology, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee
| | - Purushuttom W Laud
- Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee
| | - Rodney A Sparapani
- Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee
| | - Ann B Nattinger
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee
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Ozmen T, Polat AV, Polat AK, Bonaventura M, Johnson R, Soran A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon 2014; 13:139-44. [PMID: 24529831 DOI: 10.1016/j.surge.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
We aimed to study the factors affecting cosmetic outcome (CO) in breast conserving surgery (BCS) without oncoplastic techniques in our center with a BCS rate higher than 60% in more than 1000 breast cancer surgeries a year. In this study 284 patients who underwent BCS without oncoplastic techniques were included. Surgeries were performed by two experienced breast surgeons with more than 25 years of experience. These patients were followed in our established Wellness Clinic postoperatively. The CO is evaluated according to the "Harvard Breast Cosmesis Grading Scale" by a breast surgeon who did not participate in the patient's surgery. The correlation among patient factors (age, breast volume, menopausal status), tumor factors (size, location, distance to areola) and treatment factors (excision volume, breast skin excision, axillary surgery, adjuvant therapy) and CO were evaluated. The mean age was 57.6 [33-98] years in the successful CO group and 58.1 [34-85] years in the unsuccessful CO group (p > 0.05). The mean follow-up time was 37.9 [24-84] months. The CO was successful in 88.7% (n:252) of the patients. Tumor size, retroareolar location of the tumor, adjuvant chemotherapy administration and whole breast radiation therapy (WBRT) were correlated with a poorer CO (p < 0.05). We were able to attain a successful CO in approximately 90% of our patients. Adding oncoplastic techniques to the surgical management of larger tumors and retroareolar tumors, may increase the percentage of good CO. In selected patients choosing balloon brachytherapy instead of WBRT, may also have positive effects on CO.
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Affiliation(s)
- Tolga Ozmen
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Ahmet Veysel Polat
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ayfer Kamali Polat
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Ronald Johnson
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Atilla Soran
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Wilson NP, Wilson FP, Neuman M, Epstein A, Bell R, Armstrong K, Murayama K. Determinants of surgical decision making: a national survey. Am J Surg 2014; 206:970-7; discussion 977-8. [PMID: 24296100 DOI: 10.1016/j.amjsurg.2013.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a national survey of general surgeons to address the association between surgeon characteristics and the tendency to recommend surgery. METHODS We used a web-based survey with 25 hypothetical clinical scenarios with clinical equipoise regarding the decision to operate. The respondent-level tendency to operate (TTO) score was calculated as the average score over the 25 scenarios. Surgical volume was based on self-report. Linear regression models were used to evaluate the associations between TTO, other covariates of interest, and surgical volume. RESULTS There were 907 respondents. The mean surgical TTO was 3.05 ± .43. Surgeons had significantly lower TTO scores when responding to questions within their area of practice (P < .0001). There was no association between TTO and malpractice concerns, financial incentives, or compensation structure. CONCLUSIONS Surgeons recommend intervention far less frequently within their area of specialization. Malpractice concerns, volume, and financial compensation do not significantly affect surgical decision making.
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Affiliation(s)
- Niamey P Wilson
- Robert Wood Johnson Clinical Scholars Program, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, West Pavilion, 3rd Floor, Philadelphia, PA 19104, USA; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model. BMC Health Serv Res 2013; 13:220. [PMID: 23768234 PMCID: PMC3698106 DOI: 10.1186/1472-6963-13-220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background The majority of curative health care is organized in hospitals. As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In previous studies on allocation of hospital infrastructure, the allocation is usually only based on accessibility and/or efficiency of hospital care. In this paper, we explore the possibilities to include a quality function in the objective function, to give global directions to how the ‘optimal’ hospital infrastructure would be in the Dutch context. Methods To create optimal societal value we have used a mathematical mixed integer programming (MIP) model that balances quality, efficiency and accessibility of care for 30 ICD-9 diagnosis groups. Typical aspects that are taken into account are the volume-outcome relationship, the maximum accepted travel times for diagnosis groups that may need emergency treatment and the minimum use of facilities. Results The optimal number of hospital locations per diagnosis group varies from 12-14 locations for diagnosis groups which have a strong volume-outcome relationship, such as neoplasms, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD). Conclusions In conclusion, our study shows a new approach for allocating hospital infrastructure over a country or certain region that includes quality of care in relation to volume per provider that can be used in various countries or regions. In addition, our model shows that within the Dutch context chronic care may be too concentrated and complex and/or acute care may be too dispersed. Our approach can relatively easily be adopted towards other countries or regions and is very suitable to perform a ‘what-if’ analysis.
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Waldman LT, Svoboda L, Young BF, Abel GA, Berlin S, Elfiky AA, Freedman RA, Drews M, Holland L, Lathan CS. A novel community-based delivery model to combat cancer disparities. Healthcare (Basel) 2013; 1:123-9. [DOI: 10.1016/j.hjdsi.2013.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 11/26/2022] Open
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De Ieso PB, Coward JI, Letsa I, Schick U, Nandhabalan M, Frentzas S, Gore ME. A study of the decision outcomes and financial costs of multidisciplinary team meetings (MDMs) in oncology. Br J Cancer 2013; 109:2295-300. [PMID: 24084764 PMCID: PMC3817328 DOI: 10.1038/bjc.2013.586] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/18/2013] [Accepted: 09/05/2013] [Indexed: 11/09/2022] Open
Abstract
Background: The benefits of multidisciplinary working in oncology are now accepted as the norm and widely accepted as being pivotal to the delivery of optimal cancer care. Central to this are the multidisciplinary meetings (MDMs) and we have evaluated decision outcomes and financial costs of these. Methods: We reviewed the electronic patient records of 551 newly referred patients, discussed at 14 tumour site-specific MDMs for adult solid tumours and lymphoma (paediatric oncology and acute leukaemia were excluded) over a 1-month period, a total of 52 MDMs were studied. In addition, the records of a further 81 patients from 10 different MDMs were reviewed where the treating consultant had clearly recorded their opinion of how the patient should be managed and this was compared with the final MDM's consensus view. We also costed the MDMs utilising two different methodologies. Results: The mean age of the 551 patients in the study was 62 years. In all, 536 (97.3%) patients were treatment naive before MDM discussion and 15 (2.7%) had prior treatment. Median time to treatment after the MDM was 16 days. In 535 (97.1%) cases, the MDM discussions were clearly documented, 16 (2.9%) were not clearly documented. In total, 319 (57.9%) patients were discussed once, and 232 (42.1%) were re-discussed (one to six occasions). In 62 (12.7%) patients, there were delays in MDM discussion, 30 (48.4%) were related to radiology, 26 (41.9%) to histopathology and 6 (9.7%) a combination of both. Adherence to the MDM management plan decision occurred 503 times (91.3%) with 48 (8.7%) deviations. In the smaller cohort of 81 patients, the consultant management plan and MDM consensus was compatible 71 (87.6%) times. On four occasions, there were major alterations in management while six were minor. The cost per month of our MDMs ranged from £2192 to £10 050 (median £5136) with total cost of £80 850 per month and the cost per new patient discussed was £415. Conclusion: Adherence to MDM decisions by health-care professionals occurs in the majority of patients. MDMs are costly, which may have relevance in the currently challenged health-care financial environment. There is a need to improve MDM efficiency without losing the considerable benefits associated with regular MDMs.
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Affiliation(s)
- P B De Ieso
- Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
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Roder D, de Silva P, Zorbas HM, Kollias J, Malycha PL, Pyke CM, Campbell ID. Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status. AUST HEALTH REV 2012; 36:342-8. [PMID: 22935129 DOI: 10.1071/ah11060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/13/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status. METHOD Deaths were traced to 31 December 2007, for cancers diagnosed in 1998-2005. Risk of breast cancer death was compared using Cox proportional hazards regression. RESULTS When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower when surgeons' annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21-100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P ≥ 0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status. CONCLUSION Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.
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Affiliation(s)
- David Roder
- Population Health, Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.
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Taban F, Rapiti E, Fioretta G, Wespi Y, Weintraub D, Hugli A, Schubert H, Vlastos G, Castiglione M, Bouchardy C. Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias. Ann Oncol 2012; 24:116-25. [PMID: 22945380 DOI: 10.1093/annonc/mds285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective. PATIENTS AND METHODS We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score. RESULTS Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4). CONCLUSIONS This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.
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Affiliation(s)
- F Taban
- SONGe (Séno ONcologie Genevoise), Geneva Private Practitioners Breast Cancer Network, Geneva, Switzerland
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Peltoniemi P, Huhtala H, Holli K, Pylkkänen L. Effect of surgeon's caseload on the quality of surgery and breast cancer recurrence. Breast 2012; 21:539-43. [DOI: 10.1016/j.breast.2012.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 04/18/2012] [Indexed: 11/30/2022] Open
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Salotto J, Sariego J. Facility Size and Its Influence on the Presentation and Treatment of in Situ Breast Carcinoma in the United States. Am Surg 2012. [DOI: 10.1177/000313481207800715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have suggested that outcomes from breast cancer are improved when treatment is rendered at high-volume teaching centers. The current study was undertaken to examine the impact of facility type on the presentation and treatment of “early” breast carcinoma across the United States. Breast cancer data were available from the American College of Surgeons National Cancer Database. The cohort consisted of 305,358 patients presenting with in situ cancers and no prior treatment from 2000 to 2008. Data were stratified by type of treatment facility, “invasive” versus “noninvasive” nature of the tumor, and treatment performed. Only 15 per cent of patients presented to community cancer centers (CCCs). Despite this, a greater percentage presented with invasive disease at CCCs (82.1%) compared with comprehensive community cancer centers (CCCCs; 80%) or teaching/research facilities (T/Rs; 70.2%). In examining the in situ cohort, a higher percentage of patients at CCCs were treated with breast conservation than at CCCCs or T/Rs. Although small, these differences were statistically significant. These data do not support the contention that only “early” cases of breast cancer present and are treated at community centers. In early breast cancer, patients are as likely to receive state-of-the-art treatment at a CCC as they are at a T/R.
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Affiliation(s)
- Jennifer Salotto
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jack Sariego
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
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Abstract
The primary focus of the establishment and certification of specialized cancer centers in the context of the National Cancer Plan is to improve the quality of care for patients with various carcinoma entities. The era of organ center certification started with the establishment of specialized breast cancer centers in line with the high incidence of breast cancer, the high mortality rate and the high level of interdisciplinary cooperation in the diagnosis and therapy of breast cancer. The introduction of quality management and external monitoring aims to provide high quality care in the diagnosis and therapy of breast cancer and is expected to improve long-term quality data (disease-free survival and overall survival) and to reduce mortality rates by about 25-30%. Certification requires the implementation of a quality management system and care provision structures assuring diagnosis and therapy according to the quality guidelines and recommendations of the specialist societies. Basic requirements for improving the quality of breast cancer patient care are centralization, specialization and interdisciplinarity. It has been demonstrated that the improvement of overall survival is associated with an increasing annual case load of a center, an increasing case load per surgeon per year, study participation and interdisciplinarity. Tumor documentation will be harmonized in the future by the establishment of local clinical cancer registries and cross-linking them with the National Cancer Registry. The data collection and analysis of several quality markers and current follow-up and survival data for each breast cancer patient will allow direct comparison of participating institutions. Individual breast cancer centers may demonstrate quality improvement longitudinally. Both certification and specialization require additional services which are associated with a substantial increase in costs. Preliminary data suggest that certified breast cancer centers are dependent on cross-financing by the participating departments of a hospital. Up to now cost-effective analyses for certified breast cancer centers are not available due to a substantial lack of data defining the additional financial burden.
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Affiliation(s)
- K Hellerhoff
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Tanke MAC, Ikkersheim DE. A new approach to the tradeoff between quality and accessibility of health care. Health Policy 2012; 105:282-7. [PMID: 22444760 DOI: 10.1016/j.healthpol.2012.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Quality of care is associated with patient volume. Regionalization of care is therefore one of the approaches that is suited to improve quality of care. A disadvantage of regionalization is that the accessibility of the facilities can decrease. By investigating the tradeoff between quality and accessibility it is possible to determine the optimal amount of treatment locations in a health care system. In this article we present a new model to quantitatively 'solve' this tradeoff. We use the condition breast cancer in the Netherlands as an example. MATERIALS AND METHODS We calculated the expected quality gains in Quality Adjusted Lifetime Years (QALY's) due to stepwise regionalization using 'volume-outcome' literature for breast cancer. Decreased accessibility was operationalized as increased (travel) costs due to regionalization by using demographic data, drive-time information, and the national median income. The total sum of the quality and accessibility function determines the optimum range of treatment locations for this particular condition, given the 'volume-quality' relationship and Dutch demographics and geography. RESULTS Currently, 94 locations offer breast cancer treatment in the Netherlands. Our model estimates that the optimum range of treatment locations for this particular condition in the Netherlands varies from 15 locations to 44 locations. CONCLUSION Our study shows that the Dutch society would benefit from regionalization of breast cancer care as possible quality gains outweigh heightened travel costs. In addition, this model can be used for other medical conditions and in other countries.
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Affiliation(s)
- Marit A C Tanke
- KPMG Plexus, Straatweg 68, 3621 BR Breukelen, The Netherlands.
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Vrijens F, Stordeur S, Beirens K, Devriese S, Van Eycken E, Vlayen J. Effect of hospital volume on processes of care and 5-year survival after breast cancer: a population-based study on 25000 women. Breast 2011; 21:261-6. [PMID: 22204930 DOI: 10.1016/j.breast.2011.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/29/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators. METHODS Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and ≥ 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage. RESULTS A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals. CONCLUSION Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.
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Affiliation(s)
- France Vrijens
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique, 55, B-1000 Brussels, Belgium.
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Lux MP, Fasching PA, Loehberg CR, Jud SM, Schrauder MG, Bani MR, Thiel FC, Hack CC, Hildebrandt T, Beckmann MW. Health Services Research and Health Economy - Quality Care Training in Gynaecology, with Focus On Gynaecological Oncology. Geburtshilfe Frauenheilkd 2011; 71:1046-1055. [PMID: 26640282 PMCID: PMC4651110 DOI: 10.1055/s-0031-1280435] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022] Open
Abstract
In the era of cost increases and reduced resources in the German healthcare system, the value of health services research and health economics is increasing more and more. Health services research attempts to develop concepts for the most effective ways to organise, manage, finance and deliver high-quality care and evaluates the implementation of these concepts with regard to daily routine conditions. Goals are the assessment of benefits and the economic advantages and disadvantages of new and established diagnostic methods, drugs and vaccines. Regarding these goals, it is clear that health services research goes hand in hand with health economics, which evaluates the benefits of diagnostic and therapeutic procedures in relation to the costs. Both scientific fields have focus principally on gynaecology and particularly on gynaecological oncology in Germany, as can be seen by numerous publications. These present several advantages compared with clinical trials - they uncover gaps in health care, question the material, staffing and consequently the financial resources required and they allow the estimation of value and the comparison of different innovations to identify the best options for our patients.
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Affiliation(s)
- M P Lux
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - P A Fasching
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - C R Loehberg
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - S M Jud
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - M G Schrauder
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - M R Bani
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - F C Thiel
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - C C Hack
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - T Hildebrandt
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
| | - M W Beckmann
- Department of Gynaecology, University Hospital of Erlangen, Erlangen
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Dooley WC, Bong J, Parker J. Mechanisms of improved outcomes for breast cancer between surgical oncologists and general surgeons. Ann Surg Oncol 2011; 18:3248-51. [PMID: 21584834 DOI: 10.1245/s10434-011-1771-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prior multi-institutional studies have reported a survival benefit of breast cancer treatment by surgical oncologists (SO) over general surgeons (GS). METHODS Retrospective review tumor registry data of all breast cancer patients receiving primary treatment at a single institution from January 1, 1995, to December 31, 2008. RESULTS During the time period, there were 2192 patients who received primary breast cancer treatment at this institution. The mean age was 57 years and the mean follow-up was >55 months. Stage distribution was similar between GS and SO. Overall survival (SO 83.8% vs. GS 75.6%) and disease-free survival (SO 80.7% vs. GS 72.0%) was highly statistically significant (P<0.0001). For stages 1, 2a, 2b, 3a, and 3b there were statistically significant (P<0.05) differences for overall and disease-free survival. Overall, the use of breast conservation was more likely by SO-52.6 vs. 38.3% all stages and 65.8 vs. 54.0% for stage 0-2. The compliance with all systemic therapies (chemotherapy and hormone therapy) was more likely if being treated by SO-77.3 vs. 68.5% (P<0.02). The use of radiotherapy for breast conservation and in stage 3 mastectomy patients was higher for SO (P<0.001). Participation in clinical trials was far higher for SO patients-56.2 vs. GS 7.0% (P<0.001). CONCLUSIONS The value added by having primary breast cancer treatment by a SO seems to arise from the more successful completion of multidisciplinary care in a timely fashion and higher rates of clinical trial involvement.
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Affiliation(s)
- William C Dooley
- OU Breast Institute, University of Oklahoma, Oklahoma City, OK, USA.
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Gesundheitsökonomische Aspekte und finanzielle Probleme in den zertifizierten Strukturen des Fachgebietes. DER GYNÄKOLOGE 2011. [DOI: 10.1007/s00129-011-2807-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fjösne HE, Søreide JA, Kåresen R, Lønning PE, Jacobsen AB, Lundgren S. Hospital volume and prognosis among Norwegian breast cancer patients enrolled in adjuvant trials. Acta Oncol 2011; 50:1068-74. [PMID: 21745131 DOI: 10.3109/0284186x.2011.585998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several studies have reported an association between breast cancer unit volume and prognosis. We hypothesize that this may be due to inappropriate coping with the recommended guidelines for adjuvant therapy rather than improper breast cancer surgery provided at smaller units. METHODS A cohort of 1131 patients with operable breast cancer (pT(1-2) and positive axillary lymph nodes, stage II) enrolled between 1984 and 1994 were analyzed. The women had participated in one of three prospective trials on adjuvant endocrine treatment and were enrolled from 50 centers in Norway. The hospitals were categorized into four groups according to the annual number of surgically treated breast cancer patients reported to the national discharge database in 1990. The hospitals were also stratified according to whether they are university or non-university hospitals. To assess the effect of unit size on patient outcome, local recurrence rates and overall survival were compared in women treated at units with different patient volumes. RESULTS The median time from study enrolment to the end of the study was 10.5 years. Relapse-free survival and overall survival did not differ significantly between the hospital groups based on the surgical workload or between university and non-university hospitals. CONCLUSIONS Patient volume or teaching status of a hospital did not have any impact on the prognosis of pre- or postmenopausal stage II breast cancer patients included in the adjuvant endocrine trials. Our data support the hypothesis that differences in survival related to patient volume at the treatment units may be explained by inappropriate adjuvant systemic treatment.
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Affiliation(s)
- Hans E Fjösne
- Department of Surgery, St. Olavs University Hospital, Trondheim, Norway.
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Lietzen LW, Sørensen GV, Ording AG, Garne JP, Christiansen P, Nørgaard M, Jacobsen J. Survival of women with breast cancer in central and northern Denmark, 1998-2009. Clin Epidemiol 2011; 3 Suppl 1:35-40. [PMID: 21814468 PMCID: PMC3144776 DOI: 10.2147/clep.s20627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Breast cancer is the most common cancer among women worldwide. The Nordic countries have relatively high survival, but Denmark has a lower survival than neighboring countries. A breast cancer screening program was introduced in 2007 and 2008 in the northern and central regions of Denmark respectively. We aimed to examine possible changes in survival of Danish breast cancer patients in central and northern Denmark in the period 1998–2009. Materials and methods From the northern and central Denmark regions, we included all women (n = 13,756) with an incident diagnosis of breast cancer, as recorded in the Danish National Registry of Patients during the period January 1, 1998 through December 31, 2009. We calculated age-stratified survival and used Cox proportional hazard regression to estimate mortality rate ratios (MRRs) for all breast cancer patients. Results Median age was 62 years (21–102 years). The overall 1-year survival improved steadily over the period from 90.9% in 1998–2000 to 94.4% in 2007–2009, corresponding to a 1-year age adjusted MRR of 0.68 in 2007–2009 compared with the reference period 1998–2000. We estimated the 5-year survival to improve from 70.0% in 1998–2000 to 74.7% in 2007–2009, corresponding to a 5-year age adjusted MRR of 0.82 in 2007–2009 compared with the reference period 1998–2000. For middle-aged women (50–74 years) 1-year survival increased from 92.8% in 1998–2000 to 96.6% in 2008–2009, and 5-year survival was expected to increase from 73.9% in 1998–2000 to 80.2% in 2007–2009. Among younger women (15–49 years) and elderly women (>75 years), 1-year survival and 5-year predicted survival did not change over the two time periods. Conclusion Survival of breast cancer patients has improved in Denmark over the period 1998–2009, and this change was most distinct in women aged 50–74 years. Survival improved even before the implementation of a formal breast cancer screening program.
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