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Chi SC, Liu YC, Konara Mudiyanselage SP, Fetzer S, Lin MF. Treatment withdrawal experiences of women with breast cancer: A phenomenological study. J Clin Nurs 2024; 33:3212-3223. [PMID: 38528376 DOI: 10.1111/jocn.17142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
AIM To obtain an in-depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. BACKGROUND Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body-mind consciousness and body autonomy play a crucial role in cancer treatment decisions. DESIGN Descriptive phenomenological approach. METHODS We conducted semi-structured, face-to-face and in-depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five-step process. To ensure a comprehensive report the COREQ checklist was applied. FINDINGS 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub-themes. 'Raising Body-Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self-Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. CONCLUSION Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self-determination through self-protection. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision-making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern.
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Affiliation(s)
- Shu-Ching Chi
- Nursing Department, E-DA Hospital, Kaohsiung, Taiwan
- Nursing Department, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Chen Liu
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | | | - Susan Fetzer
- Department of Nursing, University of new Hampshire, Durham, New Hampshire, USA
| | - Mei-Feng Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wang X, Lian Z, Wu Q, Wu F, Zhang G, Liu J, Chen C, Sun J. Refusal of treatment among HER2-positive breast cancer patients in China: a retrospective analysis. Front Public Health 2024; 11:1305544. [PMID: 38303960 PMCID: PMC10832033 DOI: 10.3389/fpubh.2023.1305544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
Background There is a need to update the understanding of treatment refusal among cancer patients in China, taking into account recent developments. This study investigated how public insurance coverage of the first breast cancer targeted therapy contributed to the changes in treatment refusal among HER2-positive breast cancer patients in China. And it intensively examined and discussed additional barriers affecting patient utilization of innovative anticancer medicines based on the types and reasons for treatment refusal. Methods This retrospective study included female breast cancer patients diagnosed as HER2-positive who received treatment at a provincial oncology center in southern China between 2014 and 2020. Multivariable analysis was conducted using a binary logistic regression model. Subgroup analysis was performed with the same regression model. Results Among the 1,322 HER2-positive breast cancer patients who received treatment at the study hospital between 2014 and 2020, 327 (24.55%) had ever refused treatment. Economic reasons were reported as the primary cause by 142 patients (43.43%). Patients diagnosed after September 2017, when the first breast cancer targeted therapy was included in the public health insurance, were less likely to refuse treatment (OR = 0.64, 95% CI:0.45 ~ 0.91, p = 0.01) compared to those diagnosed before September 2017. Patients enrolled in the resident health insurance were more likely to refuse treatment (OR = 2.43, 95% CI:1.77 ~ 3.35, p < 0.001) than those enrolled in the employee health insurance. Conclusion This study reveals a high rate of treatment refusal among HER2-positive breast cancer patients, primarily attributed to financial factors. The disparity in public health insurance benefits resulted in a heavier economic burden for patients with less comprehensive benefits. Furthermore, the study identified challenges faced by patients seeking quality-assured cancer care in underdeveloped regions in China. By addressing economic barriers, promoting accurate health information, and improving cancer care capacity across the country can reduce the rate of treatment refusal.
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Affiliation(s)
- Xin Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Lian
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Qiyou Wu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Gong Zhang
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jian Liu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Akpoviroro O, Sauers NK, Akpoviroro OP, Uwandu Q, Castagne M, Rodrigues E, May P, Lewis M, Bolden B, Mirza W. Cancer treatment refusal decisions in advanced cancer: a retrospective case-control study. BMJ Support Palliat Care 2023:spcare-2022-003976. [PMID: 37295924 DOI: 10.1136/spcare-2022-003976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cancer remains one of the leading causes of death worldwide. Despite advancements in anticancer therapy, some patients decide against treatment. Our study focused on characterising therapy refusal in advanced-stage malignancies and further determining if certain variables significantly correlated with refusal, compared with acceptance. METHODS Our inclusion criteria were patients aged 18-75 years, stage IV cancers between 1 January 2010 and 31 December 2015 and treatment refusal (cohort 1 (C1)). A randomly selected group of patients with stage IV cancers who accepted treatment within the same timeframe was used for comparison (cohort 2 (C2)). RESULTS There were 508 patients in C1 and 100 patients in C2. Female sex was associated with treatment acceptance (51/100, 51.0%) than refusal (201/508, 39.6%); p=0.03. There were no associations between treatment decisions and race, marital status, BMI, tobacco use, previous cancer history, or family cancer history. Government-funded insurance was associated with treatment refusal (337/508, 66.3%) than acceptance (35/100, 35.0%); p<0.001. Age was associated with refusal (p<0.001). Average age of C1 was 63.1 years (SD:8.1) and C2 was 59.2 years (SD:9.9). Only 19.1% (97/508) in C1 were referred to palliative medicine, with 18% (18/100) in C2; p=0.8. There was a trend for patients who accepted therapy to have more comorbidities per the Charlson Comorbidity Index(p=0.08). The treatment of psychiatric disorders after cancer diagnosis was inversely associated with treatment refusal (p<0.001). CONCLUSIONS The treatment of psychiatric disorders after cancer diagnosis was associated with cancer treatment acceptance. Male sex, older age and government-funded health insurance were associated with treatment refusal in patients with advanced cancer. Those who refused treatment were not increasingly referred to palliative medicine.
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Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | | | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Myriam Castagne
- General Clinical Research Center, Clinical and Translational Science Institute, Boston University, Boston, Massachusetts, USA
| | - Elga Rodrigues
- Department of Surgery, Boston University, Boston, Massachusetts, USA
| | - Patrick May
- Department of Biostatistics, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Meredith Lewis
- Phenomic Analytics & Clinical Data Core Department, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Brian Bolden
- Department of Palliative Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
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Khankeh HR, Vojdani R, Saber M, Imanieh M. How do cancer patients refuse treatment? A grounded theory study. Palliat Care 2023; 22:10. [PMID: 36750817 PMCID: PMC9903566 DOI: 10.1186/s12904-023-01132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND All cancer patients, except for a small fraction, seek treatment after becoming aware of the disease. That small fraction do not seek any treatment due to various reasons, and this phenomenon is unknown to us. Therefore, the present study aimed to discover the reasons for treatment refusal in cancer patients. METHODS This qualitative grounded theory study was conducted on 22 participants including patients, caregivers, physicians, and nurses. Purposive theoretical sampling was employed. Data were collected through in-depth interviews. All interviews were gradually transcribed and analyzed. Data analysis was carried out through the three-step method of open, axial, and selective coding and was continued until theoretical saturation. Straussian Grounded Theory was used for data analysis. RESULTS A total of 4 themes and 20 sub-themes were extracted in this study. The core variable extracted from the interviews was "resilience" Other related themes included encounter with cancer, fighting cancer, and coping with cancer. The findings showed that in the context of fighting cancer, patients lost their resilience through various processes and refused treatment. CONCLUSION Cancer patients abandon the treatment in silence, oncologists and even family members being unaware of the matter. In other words, refusal of treatment is like an iceberg and the majority of the patients who have abandoned treatment are unknown to the health system. The model obtained in this study can increase the knowledge of the process that leads patients to lose their resilience against cancer and abandon treatment, which can increase the possibility of recognizing and predicting treatment refusal for oncologists.
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Affiliation(s)
- Hamid Reza Khankeh
- grid.472458.80000 0004 0612 774XHealth in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran ,grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Reza Vojdani
- grid.412571.40000 0000 8819 4698Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Saber
- Department of Medical Ethics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohamadhadi Imanieh
- grid.412571.40000 0000 8819 4698Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Association of treatment delay and stage with mortality in breast cancer: a nationwide cohort study in Taiwan. Sci Rep 2022; 12:18915. [PMID: 36344740 PMCID: PMC9640724 DOI: 10.1038/s41598-022-23683-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Breast cancer is the fifth leading cause of cancer death globally. In this retrospective study, we investigated the effects of the diagnosis-to-first-treatment interval (DFTI) and other related factors on cancer-specific survival in patients with breast cancer. We included 49,426 patients newly diagnosed as having breast cancer during 2011-2017. The Cox proportional hazards model was used to analyze the hazard ratio (HR) for mortality with various DFTIs; the HRs of the 31-60-, 61-90-, and ≥ 91-day DFTI groups did not differ significantly compared with the reference group (DFTI ≤ 30 days). After stratifying the patients according to initial tumor stage and age, we found that patients aged 55-64 and ≥ 65 years with stage II breast cancer treated ≥ 91 days after diagnosis had a 3.34- and 2.93-fold higher mortality risk (95% confidence intervals [CIs] 1.29-8.69 and 1.06-8.10, respectively). Patients aged ≥ 65 years with stage IV breast cancer treated within 61-90 or ≥ 91 days after diagnosis had a 7.14- and 34.78-fold higher mortality risk (95% CIs 1.28-39.82 and 3.08-393.32, respectively). In conclusion, DFTI is associated with mortality in patients with stage II and IV breast cancer, especially at an older age.
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Boman C, Edman Kessler L, Bergh J, Matikas A, Foukakis T. Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study. Breast Cancer Res Treat 2022; 194:49-56. [PMID: 35461374 PMCID: PMC9167164 DOI: 10.1007/s10549-022-06591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite therapeutic advances, overall survival of metastatic breast cancer (MBC) at the population level has seen little improvement over the past decades. Aggressive tumor biology or delay in access to cancer care might be contributing factors. With this retrospective population-based study we aimed to quantify and characterize patients with very short survival time following MBC diagnosis. METHODS Women diagnosed with MBC between Jan 1st, 2005 and Dec 31st, 2016 were identified using the population-based Stockholm-Gotland breast cancer registry. Data regarding demographic and clinicopathological characteristics, survival, and treatment were extracted retrospectively from the registry and from patient charts. Patients who died within 90 days following diagnosis of MBC were identified and their characteristics were compared with all other patients diagnosed with MBC during the same period. RESULTS Between 2005 and 2016, 3124 patients were diagnosed with MBC, of whom 498 (16.2%) died within 90 days of diagnosis. Nearly half (N = 233) did not receive any antitumoral treatment. Patients with short survival were older (p < 0.001), had higher primary tumor grade (p < 0.001), higher clinical stage at primary diagnosis (p = 0.002), and more often estrogen receptor (ER)-negative breast cancer (p < 0.001). Visceral metastases were more frequent (p < 0.001) and patients with short survival received adjuvant chemotherapy (p < 0.001) to a lesser extent compared to patients with a better prognosis. In multivariable analysis older age, time period of diagnosis, metastasis site, adjuvant chemotherapy, and primary tumor grade were independent predictors for short survival, whereas ER status was not. CONCLUSION Nearly one out of six patients with MBC survive less than 3 months after diagnosis. Our findings demonstrate a different spectrum of MBC at population level and can potentially inform on individualized follow-up strategies and treatment algorithms.
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Affiliation(s)
- Caroline Boman
- Department of Oncology and Pathology, Karolinska Institute, Visionsgatan 4, Bioclinicum, 171 74, Stockholm, Sweden.
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Luisa Edman Kessler
- Department of Oncology and Pathology, Karolinska Institute, Visionsgatan 4, Bioclinicum, 171 74, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institute, Visionsgatan 4, Bioclinicum, 171 74, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology and Pathology, Karolinska Institute, Visionsgatan 4, Bioclinicum, 171 74, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Theodoros Foukakis
- Department of Oncology and Pathology, Karolinska Institute, Visionsgatan 4, Bioclinicum, 171 74, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Mohd Mujar NM, Dahlui M, Emran NA, Hadi IA, Yan YW, Arulanantham S, Chea CH, Mohd Taib NA. Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control. JCO Glob Oncol 2022; 8:e2100250. [PMID: 35286134 PMCID: PMC8932493 DOI: 10.1200/go.21.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 months (range, 1 month to 10 years), 2.4 months (range, 7 days to 10 years), 26 days (range, 4 days to 9.3 months), and 21 days (range, 1 day to 7.2 months), respectively. Meanwhile, the median time for the diagnosis subinterval of referral, biopsy, report, and diagnosis resolution was 8 days (range, 0 day to 8 months), 0 day (range, 0 day to 20 days), 7 days (range, 3 days to 3.5 months), and 4 days (range, 1 day to 1.8 months), respectively. CONCLUSION The BCC timeliness framework is based on the current sequenced trajectory of the BCC journey. Clarity in the measurement of timeliness provides a standardized language for monitoring and outcome research. It can serve as a quality indicator for community and hospital-based breast cancer programs.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, UM Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia
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Omland T, Heck SL, Gulati G. The Role of Cardioprotection in Cancer Therapy Cardiotoxicity: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2022; 4:19-37. [PMID: 35492815 PMCID: PMC9040117 DOI: 10.1016/j.jaccao.2022.01.101] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/11/2022] Open
Abstract
Cardiotoxicity is a relatively frequent and potentially serious side effect of traditional and targeted cancer therapies. Both general measures and specific pharmacologic cardioprotective interventions as well as imaging- and biomarker-based surveillance strategies to identify patients at high risk have been tested in randomized controlled trials to prevent or attenuate cancer therapy-related cardiotoxic effects. Although meta-analyses including early trials suggest an overall beneficial effect, there is substantial heterogeneity in results. Recent randomized controlled trials of neurohormonal inhibitors in patients receiving anthracyclines and/or human epidermal growth factor receptor 2-targeted therapies have shown a lower rate of cancer therapy-related cardiac dysfunction than previously reported and a modest or no sustained effect of the interventions. Data on preventive cardioprotective strategies for novel cancer drugs are lacking. Larger, prospective multicenter randomized clinical trials testing traditional and novel interventions are required to more accurately define the benefit of different cardioprotective strategies and to refine risk prediction and identify patients who are likely to benefit.
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Key Words
- ACE, angiotensin-converting enzyme
- ADT, androgen deprivation therapy
- ARB, angiotensin receptor blocker
- CMR, cardiovascular magnetic resonance
- CTRCD, cancer therapy–related cardiac dysfunction
- GLS, global longitudinal strain
- GnRH, gonadotropin-releasing hormone
- HER2 therapy
- HER2, human epidermal growth factor receptor 2
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MRA, mineralocorticoid receptor antagonist
- RR, risk ratio
- anthracycline
- cardiomyopathy
- prevention
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Affiliation(s)
- Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Lagethon Heck
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Geeta Gulati
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
- Department of Cardiology, Division of Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
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Vanderpuye V, Dadzie MA, Huo D, Olopade OI. Assessment of Breast Cancer Management in Sub-Saharan Africa. JCO Glob Oncol 2021; 7:1593-1601. [PMID: 34843373 PMCID: PMC8624034 DOI: 10.1200/go.21.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To document progress and bottlenecks in breast cancer management in sub-Saharan Africa, subsequent to a 2013 pilot survey conducted through the African Organization for Research and Treatment in Cancer (AORTIC) network. METHODS An anonymous survey of breast cancer management was conducted in 2018 among AORTIC members. Results concerning respondent specialty, access to tumor boards, treatment accessibility, diagnostic services, and factors influencing treatment outcomes were compared with the 2013 findings. RESULTS Thirty-seven respondents from 30 facilities in 21 sub-Saharan Africa countries responded. The majority (92%) were clinical oncologists. Radiotherapy facilities were available in 70% of facilities. Seventy-eight percent of these had linear accelerators, and 42% had cobalt60 machines. Eighty percent of facilities had multidisciplinary tumor boards. Immunohistochemistry was routinely performed in 74% of facilities, computed tomography scan in 90%, bone scan in 16%, and positron emission tomography scans in 5%. Anthracyclines, taxanes, tamoxifen, letrozole, anastrozole, and zoledronic acid were available in the majority; trastuzumab, fertility, and genetic counseling were available in 66%, 58%, and 16%, respectively. There were a 50% increase in oncologist respondents over 2013 and a > 50% increase in radiotherapy facilities, particularly linear accelerators. Availability of trastuzumab, aromatase inhibitors, and taxanes increased. Immunohistochemistry capacity remained the same, whereas facilities harvesting at least 10 axillary lymph nodes increased. Bone scan facilities decreased. Responses suggested improved diagnostic services, systemic therapies, and radiotherapy. Sociocultural and economic barriers, system delays, and advanced stage at presentation remain. CONCLUSION Clinicians in sub-Saharan Africa have basic tools to improve breast cancer outcomes, recording positive strides in domains such as radiotherapy and systemic therapy. Socioeconomic and cultural barriers and system delays persist. Workforce expansion must be prioritized to improve quality of care to improve outcomes. This study highlights the current state of breast cancer management in Sub Saharan Africa, documenting key advancements , challenges and bottlenecks encountered in the sub region. Aside the major aspects of management, pertinent areas such as multidisciplinary tumour board engagements, fertility , genetic counselling and factors affecting outcome were explored. Majority of institutions manage breast cancer patients within a multidisciplinary setting using standard treatment guidelines. The high out of pocket cost of cancer treatment and advanced stage at presentation transcends in many sub Saharan countries negatively impacting outcomes. These results should serve as a benchmark to stakeholders , to guide urgent interventions required to further improve outcomes.
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Affiliation(s)
- Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mary-Ann Dadzie
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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Shahi S, Meza J, Tandra P, LeVan T, Bagenda DS, Farazi PA. Gender Differences in Recommended Treatment Decisions among Breast Cancer Patients: A Study Using the National Cancer Database. Clin Breast Cancer 2021; 22:e444-e456. [PMID: 34949552 DOI: 10.1016/j.clbc.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have explored surgery refusal among female breast cancer patients. However, little attention has been given to other therapies in both females and males. The goal of this study was to determine the potential role of gender on recommended hormone therapy, chemotherapy, radiation therapy, and surgery refusal and to describe other determinants of refusal. MATERIALS AND METHODS A retrospective study of the National Cancer Database (NCDB) between 2004 and 2016 was conducted. The outcome was whether patients accepted or refused the recommended treatment. We examined four different outcome variables (hormone therapy, chemotherapy, radiation therapy, and surgery) relation to gender and other factors. RESULTS A total of 906,342 breast cancer patients met the eligibility criteria for hormone therapy, 1,228,132 for surgery, 596,229 for chemotherapy, and 858,050 for radiation therapy. The odds of refusing hormone therapy and surgery in males were 17% (AOR = 0.83; 95% CI: 0.75-0.92) and 33% (AOR=0.67; 95% CI: 0.50-0.90) lower compared to female patients, respectively. The odds of refusing radiation therapy were 14% higher in males compared to females (AOR=1.14; 95% CI:1.03-1.30). Older age and lack of insurance were significantly associated with each treatment refusal. CONCLUSION Female patients tend to refuse hormone therapy and surgery compared to males. A marginally statistically significant gender differences was found for radiotherapy refusal. The providers and other stakeholders can utilize the current findings to identify the risk groups and barriers associated with refusal for each treatment and to develop interventions.
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Affiliation(s)
- Shamim Shahi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Pavankumar Tandra
- Department of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Tricia LeVan
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Danstan S Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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Medeiros GC, Thuler LCS, Bergmann A. Determinants of delay from cancer diagnosis to treatment initiation in a cohort of brazilian women with breast cancer. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1769-1778. [PMID: 33438787 DOI: 10.1111/hsc.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/18/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
This objective this study was to identify the time interval between breast cancer (BC) diagnosis and treatment initiation and delay-associated factors. This is a prospective cohort study that followed breast cancer patients, enrolled and treated at the cancer center in Rio de Janeiro (RJ) - Brazil, from October 02, 2014 to April 30, 2015. Participants were interviewed at the first consultation. Treatment-related information was collected six months after recruitment. The median and interquartile range (IQR) were calculated. The interval between breast cancer diagnosis and treatment initiation of more than 60 days was considered the delay, according to the maximum term determined by Brazilian law. The association between independent variables and the outcome was performed using the crude odds ratios (OR). Variables presenting p < .20 in the univariate analysis were included in the multiple logistic regression model by the stepwise forward method, and those with p < .05 were retained in the final model. A total of 470 patients were included in the study. The median time was of 127 days (IQR: 85- 174). Delay was observed in 89.1% of the cases. After adjustment, the variables associated with delay were age ≥ 60 years (OR: 2.48; 95% CI 1.22-5.06), initial clinical staging (<2B) (OR: 2.01; 95% CI 1.05-3.86) and residence outside the city of Rio de Janeiro (OR: 2.75; 95% CI 1.38-5.51). Delays in starting treatment were associated with sociodemographic and clinical factors. Improving patient quality of care and restructuring the health service can minimise delays.
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Affiliation(s)
| | - Luiz C S Thuler
- Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Illahi AN, Hendrati LY. Alternative Medicine-Seeking Behavior among Cancer Patients at The Indonesian Cancer Foundation. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i32021.284-292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: A large proportion of cancer deaths are caused by patient delay in accessing hospital treatment. One of the causes of such delays is the use of alternative medicine. Purpose: This research is conducted to determine the characteristics and factors related to the behavior of seeking treatment in the form of alternative medicine among cancer patients at the Indonesian Cancer Foundation (Yayasan Kanker Indonesia). Methods: This research is a quantitative descriptive research with a cross-sectional study design. The target of the research is all patients who temporarily stayed at the Yayasan Kanker Indonesia from February–April 2020, a total of 45 patients aged ≥ 17 years who had been diagnosed with cancer. The data was obtained via questionnaires and interviews. The variables examined are the predisposition factors (sex, age, education, occupation, stage of cancer, time ranges for accessing health services after symptom onset, prior illness, family history), enabling factors (distance to health services, income, health insurance), and reinforcing factors (family support and information resources). Analysis of research data was conducted using frequency tables and Chi-Square or Fisher's Exact test. Results: The factors related to the behavior of seeking treatment via alternative medicine in cancer patients at Yayasan Kanker Indonesia are the stage of cancer (p=0.04), the time span between symptom onset and checking into health services (p=0.02), and length of illness (p=0.03). Conclusion: Alternative treatment search behavior is influenced by several factors, namely the stage of cancer, the time span between symptom onset and checking into health services, and the length of illness.
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Chang NT, Chang YH, Huang YT, Chen SC. Factors Associated with Refusal or Discontinuation of Treatment in Patients with Bladder Cancer: A Cohort Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020618. [PMID: 33450864 PMCID: PMC7828302 DOI: 10.3390/ijerph18020618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
Cancer treatment causes adverse effects that lead to refusal or discontinuation of treatment. The purposes of this study were to identify 1) the factors associated with and 2) the reasons for refusing and discontinuing treatment in patients with bladder cancer (BC). We conducted a retrospective cohort study in patients diagnosed with BC in Taiwan from 1 January 2014 to 30 June 2019 using a linked cancer registry database. Of the 1247 BC patients in the study cohort, 2.1% reported refusing treatment. Patients with less education and those diagnosed at cancer stage II-IV were more likely to refuse treatment. The major reason for refusing treatment was "patient or the family considered patient's poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment". A total of 4.3% of BC patients reported discontinuing treatment. Patients not living in the northern region of Taiwan and those diagnosed at cancer stage II-IV were more likely to terminate treatment before completion. The major reason given for discontinuing treatment was inconvenient transportation. Sufficient social resources and supportive care can help BC patients cope with the physical and psychological burden of treatment.
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Affiliation(s)
- Nai-Tan Chang
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei Municipal Tucheng Hospital Chang Gung Memorial Hospital, New Taipei 236, Taiwan;
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
| | - Shu-Ching Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Correspondence:
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Wong XY, Lim AQJ, Shen Q, Chia JWK, Chew MH, Tan WS, Wee HL. Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment. Curr Med Res Opin 2020; 36:1677-1686. [PMID: 32609014 DOI: 10.1080/03007995.2020.1790348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients' preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies. METHODS Discrete choice experiment (DCE) was administered to English- or Chinese-speaking Stage 2 or 3 colon cancer patients at the National Cancer Centre Singapore. DCE attributes comprise progression-free survival (PFS), severity of acne-like skin rashes, severity of bleeding, out-of-pocket cost per month and frequency of drug administration. Mixed logit model was used to calculate preference weights for all attribute levels. Subgroup analyses were conducted by interacting attribute levels with selected respondent characteristics. Relative uptake rates for various medication scenarios were studied. RESULTS 169 respondents aged 61.5 ± 10.5 years completed the survey. They placed the greatest weight on cost, followed by bleeding and skin rashes, then PFS and finally frequency of drug administration. This was similarly observed in the subgroup analyses. A scenario with shorter PFS but less severe side effects has a slightly higher relative uptake at 55%. One quarter of respondents reported that they would not take the treatment they preferred in the choice task. CONCLUSION Patients were willing to trade off some degree of efficacy to avoid certain severity of side effects. It is therefore crucial for patients and physicians to discuss patients' preferences and circumstances to understand which attributes are more important, as well as patients' views on the trade-offs between treatment benefits and risks.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Qi Jun Lim
- NUS Science Research Programme, Hwa Chong Institution (College Section), Singapore, Republic of Singapore
| | - Qianyu Shen
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - John Whay Kuang Chia
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Min Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Wah Siew Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
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Wu SG, Shi J, Zhang WW, Wang J, Lian CL, Lei J, Hua L, Zhou J, He ZY. Prognostic validation and treatment decision making of the 8 th edition of the American Joint Committee on Cancer pathological staging system for elderly women with early-stage breast cancer. Aging (Albany NY) 2020; 12:15077-15090. [PMID: 32710731 PMCID: PMC7425443 DOI: 10.18632/aging.103574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/13/2020] [Indexed: 12/24/2022]
Abstract
Purpose: To determine the prognostication and treatment decision making of the American Joint Committee on Cancer (AJCC) 8th pathological staging system in elderly women (aged ≥65 years) with T1-2N0M0 breast cancer (BC). Results: We included 67699 patients, and patients were restaged into stage IA (84.9%), IB (8.9%), and IIA (6.2%) using the 8th AJCC edition criteria. Overall, 69.4% and 30.6% of them underwent breast-conservation surgery (BCS) and mastectomy (MAST), respectively. In patients who received BCS, 30.3% of them underwent postoperative radiotherapy (RT). Patients with a higher pathological stage were more likely to receive MAST. The 5-year breast cancer-specific mortality rate was 2.2%, 6.5% and 13.7% in stage IA, IB, and IIA, respectively. Patients treated with BCS and RT had significantly lower risk of breast cancer-specific mortality compared to those treated with MAST or with BCS alone regardless of the pathological prognostic stages (P<0.001). Conclusions: The 8th AJCC pathological prognostic staging system provides accurate risk stratification and impacts the treatment decision making for elderly women with early-stage BC. Methods: We identified stage T1-2N0M0 BC patients using the Surveillance, Epidemiology, and End Results database. Statistical analyses were used binomial logistic regression, and multivariable competing risk models in the Cox model framework.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Jian Shi
- Department of Breast Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518083, People's Republic of China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Jian Lei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Li Hua
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China
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Li S, Alapati A, Riba L, Fleishman A, James TA, Sharma R. Delayed adjuvant hormonal therapy and its impact on mortality in women with breast cancer. Breast J 2019; 26:952-959. [PMID: 31602749 DOI: 10.1111/tbj.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
Adjuvant hormonal therapy (HT) is important for the management of hormone-sensitive breast cancer. However, the timeliness for adjuvant HT and the consequences of delayed initiation of treatment have not been analyzed. The purpose of this study was to characterize delays to HT and assess the impact on clinical outcomes. The study cohort consisted of female patients with invasive ductal and/or lobular, hormone receptor-positive breast cancer diagnosed between 2010 and 2015. Initiation of HT >6 months (180 days) after surgery was defined as delayed. Patients receiving chemotherapy were excluded from the study cohort. Multivariable logistic regression modeling was performed to establish associations between delayed HT and demographic, facility, and clinical factors. Survival analysis was performed using the Kaplan-Meier estimation and Cox proportional hazards regression to evaluate overall survival. Of 179 590 women assessed in the National Cancer Database, 3.2% had a delay in the initiation of adjuvant HT. Positive demographic-related risk factors were younger age, ethnic minority groups, and multiple comorbidities. Clinical factors significantly associated with delayed initiation of adjuvant HT were high-grade tumor, larger tumor size, greater lymph node involvement, having an unplanned readmission within 30 days of surgery, and positive final surgical margins. Adjusted survival analysis showed a survival disadvantage of delayed initiation of HT. Risk factors for delayed initiation of HT specific to demographic and clinical characteristics were identified. Delayed initiation of HT was associated with a survival detriment.
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Affiliation(s)
- Shen Li
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Amulya Alapati
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Luis Riba
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aaron Fleishman
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ted A James
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ranjna Sharma
- Section of Breast Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Section of Breast Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY
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MacEwan JP, Doctor J, Mulligan K, May SG, Batt K, Zacker C, Lakdawalla D, Goldman D. The Value of Progression-Free Survival in Metastatic Breast Cancer: Results From a Survey of Patients and Providers. MDM Policy Pract 2019; 4:2381468319855386. [PMID: 31259249 PMCID: PMC6589981 DOI: 10.1177/2381468319855386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/05/2019] [Indexed: 01/27/2023] Open
Abstract
Background. Value assessments and treatment decision making typically focus on clinical endpoints, especially overall survival (OS). However, OS data are not always available, and surrogate markers may also have some value to patients. This study sought to estimate preferences for progression-free survival (PFS) relative to OS in metastatic breast cancer (mBC) among a diverse set of stakeholders—patients, oncologists, and oncology nurses—and estimate the value patients and providers place on other attributes of treatment. Methods. Utilizing a combined conjoint analysis and discrete choice experiment approach, we conducted an online prospective survey of mBC patients and oncology care providers who treat mBC patients across the United States. Results. A total of 299 mBC patients, 100 oncologists, and 99 oncology nurses completed the survey. Virtually all patients preferred health state sequences with contiguous periods of PFS, compared with approximately 85% and 75% of nurses and oncologists, respectively. On average, longer OS was significantly (P < 0.01) preferred by the majority (75%) patients, but only 15% of nurses preferred longer OS, and OS did not significantly affect oncologists’ preferred health state. However, in the context of a treatment decision, whether a treatment offered continuous periods of stable disease holding OS constant significantly affected nurses’ treatment choices. Patients and providers alike valued reductions in adverse event risk and evidence from high-quality randomized controlled clinical trials. Conclusions. The strong preference for observed PFS suggests more research is warranted to better understand the reasons for PFS having positive value to patients. The results also suggest a range of endpoints in clinical trials may have importance to patients.
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Affiliation(s)
| | - Jason Doctor
- Precision Health Economics, Los Angeles, California
| | | | | | | | | | | | - Dana Goldman
- Precision Health Economics, Los Angeles, California
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Gaitanidis A, Alevizakos M, Tsalikidis C, Tsaroucha A, Simopoulos C, Pitiakoudis M. Refusal of Cancer-Directed Surgery by Breast Cancer Patients: Risk Factors and Survival Outcomes. Clin Breast Cancer 2018; 18:e469-e476. [PMID: 28784267 DOI: 10.1016/j.clbc.2017.07.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND It has been reported that some patients with breast cancer may refuse cancer-directed surgery, but the incidence in the United States is not currently known. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with refusal of recommended breast cancer-directed surgery. PATIENTS A retrospective review of the Surveillance Epidemiology and End Results (SEER) database between 2004 and 2013 was performed. Patients who underwent cancer-directed surgery were compared with patients in whom cancer-directed surgery was refused, even though it was recommended. RESULTS Of 531,700 patients identified, 3389 (0.64%) refused surgery. An increasing trend was observed from 2004 to 2013 (P = .009). Older age (50-69: odds ratio [OR] 4.96; 95% confidence interval, 1.23-19.96; P = .024, ≥ 70 years: OR 17.27; 95% CI, 4.29-69.54; P < .001), ethnicity (P < .001), marital status (single: OR 2.28; 95% CI, 1.98-2.62; P < .001, separated/divorced/widowed: OR 2.26; 95% CI, 2.01-2.53; P < .001), higher stage (II: OR 2.05; 95% CI, 1.83-2.3; P < .001, III: OR 2.2; 95% CI, 1.87-2.6; P < .001, IV: OR 13.3; 95% CI, 11.67-15.16; P < .001), and lack of medical insurance (OR 2.11; 95% CI, 1.59-2.8; P < .001) were identified as risk factors associated with refusal of surgery. Survival analysis showed a 2.42 higher risk of mortality in these patients. CONCLUSION There has been an increasing rate of patients refusing recommended surgery, which significantly affects survival. Age, ethnicity, marital status, disease stage, and lack of insurance are associated with higher risk of refusal of surgery.
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Affiliation(s)
- Apostolos Gaitanidis
- Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece.
| | - Michail Alevizakos
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christos Tsalikidis
- Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Alexandra Tsaroucha
- Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Constantinos Simopoulos
- Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
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Okcu Y, Rustemeyer J. Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading. J Craniomaxillofac Surg 2018; 46:858-867. [PMID: 29622289 DOI: 10.1016/j.jcms.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/14/2018] [Accepted: 03/02/2018] [Indexed: 11/24/2022] Open
Abstract
Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3). Groups 1 (p = 0.045) and 2 (p = 0.034) showed significantly shorter delays when compared with Group 3. Significant differences in average counts of implants placed were also found between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019). The ratio of planned to placed implants was highest in Group 1. The observed differences between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019) were significant. Our results indicate an accelerating effect of CAD/CAM on graft consolidation and dental rehabilitation.
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Affiliation(s)
- Yunus Okcu
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Jan Rustemeyer), Plastic Operations, Klinikum Bremen-Mitte, Medical School of the University of Göttingen, Sankt-Jürgen-Str. 1, 28177, Bremen, Germany.
| | - Jan Rustemeyer
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Jan Rustemeyer), Plastic Operations, Klinikum Bremen-Mitte, Medical School of the University of Göttingen, Sankt-Jürgen-Str. 1, 28177, Bremen, Germany
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Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2018; 158:1057-1064. [DOI: 10.1177/0194599818755353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P < .01), were of Black (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28-1.74) or Asian (OR = 1.79; 95% CI, 1.46-2.20) ethnicity, were unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.
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Chiang TY, Wang CH, Lin YF, You JF, Chen JS, Chen SC. Colorectal cancer in Taiwan: A case-control retrospective analysis of the impact of a case management programme on refusal and discontinuation of treatment. J Adv Nurs 2017; 74:395-406. [DOI: 10.1111/jan.13443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Ting-Yu Chiang
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Graduate Institute of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Chao-Hui Wang
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Fen Lin
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Jeng-Fu You
- Division of Colorectal Surgery; Department of Surgery; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Jinn-Shiun Chen
- Division of Colorectal Surgery; Department of Surgery; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Shu-Ching Chen
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Graduate Institute of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Department of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Department of Radiation Oncology; Proton and Radiation Therapy Center; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
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Suh WN, Kong KA, Han Y, Kim SJ, Lee SH, Ryu YJ, Lee JH, Shim SS, Kim Y, Chang JH. Risk factors associated with treatment refusal in lung cancer. Thorac Cancer 2017. [PMID: 28627788 PMCID: PMC5582461 DOI: 10.1111/1759-7714.12461] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer. Methods We retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti‐cancer treatment and allowed only palliative care were classified into the non‐treatment group, while the remaining 468 who received anti‐cancer treatment were classified into the treatment group. Results The groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage (P < 0.05). In logistic regression analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.07–1.13), educational status lower than high school (OR 1.95, 95% CI 1.2–3.2), no history of surgery (OR 2.29, 95% CI 1.4–3.7), body mass index < 18.5 (OR 2.49, 95% CI 1.3–4.7), and a high Eastern Cooperative Oncology Group score of 3 or 4 (OR 5.02, 95% CI 2.3–10.8) were significant factors for refusal of cancer treatment. Conclusion Individual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients.
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Affiliation(s)
- Won Na Suh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Yeji Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sung Shine Shim
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
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Faivre JC, Adam V, Block V, Metzger M, Salleron J, Dauchy S. Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer. Support Care Cancer 2017; 25:3425-3435. [PMID: 28597252 DOI: 10.1007/s00520-017-3762-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. METHODS The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. RESULTS We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. CONCLUSION The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.
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Affiliation(s)
- J C Faivre
- Academic Department of Radiation Therapy and Brachytherapy, Lorraine Institute of Cancerology - Alexis-Vautrin CLCC [Centre de lutte contre le cancer - Cancer Center] - Unicancer, 6 avenue de Bourgogne - CS 30 519, F-54511, Vandoeuvre-lès-Nancy cedex, France.
| | - V Adam
- Supportive Care in Cancer Department, Institut de Cancérologie de Lorraine, F-54500, Vandœuvre-lès-Nancy, France
| | - V Block
- French Association for Supportive Care in Cancer, 20 rue leblanc, F-7515, Paris, France
| | - M Metzger
- Institut de Cancérologie de Lorraine, Medical Library, F-54500, Vandœuvre-lès-Nancy, France
| | - J Salleron
- Biostatistics and Epidemiology Department, Institut de Cancérologie de Lorraine, F-54500, Vandœuvre-lès-Nancy, France
| | - S Dauchy
- Gustave Roussy, Département de Soins de Support, Université Paris-Saclay, F-94805, Villejuif, France.,ES3, EA1610, Université Paris-Sud, Paris, France
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Tsai WC, Kung PT, Wang YH, Huang KH, Liu SA. Influence of time interval from diagnosis to treatment on survival for oral cavity cancer: A nationwide cohort study. PLoS One 2017; 12:e0175148. [PMID: 28388649 PMCID: PMC5384671 DOI: 10.1371/journal.pone.0175148] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We aimed to explore the relationship between the time interval from diagnosis to treatment and survival of oral cavity squamous cell carcinoma patients. MATERIALS AND METHODS A population-based study was conducted between 2004 and 2010. Claims data of oral squamous cell carcinoma patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from Taiwan's National Health Insurance Research Database. RESULTS A total of 21,263 patients were included in the final analysis. The majority of the patients received treatment within 30 days of diagnosis (n = 18,193, 85.5%), while 572 patients (2.7%) underwent treatment after 120 days. The patients who were treated after 120 days had a higher risk of death when compared to those treated within 30 days (Hazard ratio: 1.32, 95% Confidence intervals: 1.19 to 1.47). CONCLUSION A longer time interval from diagnosis to treatment was found to be associated with a poorer prognosis among patients suffering from oral squamous cell carcinoma.
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Affiliation(s)
- Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Shih-An Liu
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
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Vanderpuye VDNK, Olopade OI, Huo D. Pilot Survey of Breast Cancer Management in Sub-Saharan Africa. J Glob Oncol 2016; 3:194-200. [PMID: 28717760 PMCID: PMC5493219 DOI: 10.1200/jgo.2016.004945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose To understand the current state of breast cancer management in sub-Saharan Africa. Methods We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. Results Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment. Conclusion This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.
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Affiliation(s)
- Verna D N K Vanderpuye
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
| | - Dezheng Huo
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
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Shen SC, Hung YC, Kung PT, Yang WH, Wang YH, Tsai WC. Factors involved in the delay of treatment initiation for cervical cancer patients: A nationwide population-based study. Medicine (Baltimore) 2016; 95:e4568. [PMID: 27537583 PMCID: PMC5370809 DOI: 10.1097/md.0000000000004568] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 11/25/2022] Open
Abstract
Cervical cancer ranks as the fourth leading cause of cancer death in women worldwide. In Taiwan, although the universal health insurance system has achieved 99.9% coverage and ensured easy access to medical care, some cervical cancer patients continue to delay initiation of definitive treatment after diagnosis. This study focused on cervical cancer patients who delayed treatment for at least 4 months, and examined the characteristics, related factors, and survival in these patients.Data on patients with a new confirmed diagnosis of cervical cancer by the International Federation of Gynecology and Obstetrics (FIGO) staging system between 2005 and 2010 were obtained from the National Health Insurance Research Database and the Taiwan Cancer Registry. Logistic regression analysis was performed to analyze the association of various factors with treatment delay. The Cox proportional hazards model was used to analyze the effects of various factors on mortality risk.The rate of treatment delay for cervical cancer decreased steadily from 6.46% in 2005 to 2.48% in 2010. Higher rates of treatment delay were observed among patients who were aged ≥75 years (9.91%), had severe comorbidity, had stage IV (9.50%), diagnosing hospital level at nonmedical center, or at public hospital ownership. Factors that correlated with treatment delay were age ≥75 years (odds ratio [OR] = 2.42), higher comorbidity Charlson comorbidity index (CCI) 4-6, or ≥7 (OR = 1.60, 2.00), cancer stage IV (OR = 2.60), the diagnosing hospital being a regional, district hospital, or other (OR = 3.00, 4.01, 4.60), and at public hospital ownership. Those who delayed treatment had 2.31 times the mortality risk of those who underwent timely treatment (P < 0.05).Delayed cervical cancer treatment in Taiwan was associated with age, comorbidity, cancer stage, diagnosing hospital level, and hospital ownership. Delaying treatment for ≥4 months substantially raised mortality risk in cervical cancer patients.
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Affiliation(s)
- Szu-Ching Shen
- Department of Public Health
- Department of Health Services Administration, China Medical University, Taichung
- Department of Medical Affairs, Buddhist Dalin Tzu Chi Hospital, Chiayi
- Department of Health Services Administration, Chia Nan University of Pharmacy and Science, Tainan
| | - Yao-Ching Hung
- Department of Obstetrics and Gynecology, China Medical University Hospital
- Graduate Institution of Clinical Medical Science, School of Medicine, China Medical University
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Wen-Hui Yang
- Department of Health Services Administration, China Medical University, Taichung
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung
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Effects of non-sporting and sporting qigong on frailty and quality of life among breast cancer patients receiving chemotherapy. Eur J Oncol Nurs 2016; 21:257-65. [DOI: 10.1016/j.ejon.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/16/2015] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
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Characteristics of breast cancer in Central China, literature review and comparison with USA. Breast 2016; 30:208-213. [PMID: 27017410 DOI: 10.1016/j.breast.2016.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/10/2016] [Accepted: 01/17/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This work was to analyze characteristics of breast cancer (BC) in Central China, summarize main characteristics in China and compare with USA. METHODS BC main characteristics from four hospitals in Central China from 2002 to 2012 were collected and analyzed. All the single and large-scale clinical reports covering at least ten years were selected and summarized to calculate the BC characteristics of China. BC Characteristics in USA were selected based on the database from Surveillance, Epidemiology, and End Results (SEER) Program. RESULTS Age distribution in Central China was normal with one age peak at 45-49 years, displaying differences from USA and Chinese American with two age peaks. BC characteristics in Central China displayed distinct features from USA and Chinese American, including significant younger onset age, lower proportion of patients with stage I, lymph node negative, small tumor size and ER positive. A total ten long-term and large-scale clinical reports were selected for BC characteristics of Mainland China analysis. A total of 53,571 BC patients were enrolled from 1995 to 2012. The main characteristics of BC in Mainland China were similar as that in Central China, but were significant different from developed regions of China (Hong Kong and Taiwan), USA and Chinese American. CONCLUSIONS BC characteristics in Central China displayed representative patterns of Mainland China, while showed distinct patterns from Chinese patients in other developed areas and USA.
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