Communication and planning at the end-of-life: A survey of women with advanced stage breast cancer

AbstractLittle is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357–1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.

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Defining end of life in dementia: A systematic review

Palliative Medicine ◽

10.1177/02692163211025457 ◽

2021 ◽

pp. 026921632110254

Author(s):

Bria Browne ◽

Nuriye Kupeli ◽

Kirsten J Moore ◽

Elizabeth L Sampson ◽

Nathan Davies

Keyword(s):

Systematic Review ◽

End Of Life ◽

Healthcare Professionals ◽

Functional Decline ◽

Advanced Stage ◽

Family Carers ◽

Inclusion Criteria ◽

Single Measure ◽

People With Dementia ◽

Limiting Condition

Background: Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia. Aim: To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia. Design: Systematic review and narrative synthesis. Data Sources: Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia. Results: Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life. Conclusion: End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.

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Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06170-2 ◽

2021 ◽

Author(s):

Elizabeth Buckley ◽

Elisabeth Elder ◽

Sarah McGill ◽

Zahra Shahabi Kargar ◽

Ming Li ◽

...

Keyword(s):

Breast Cancer ◽

Socioeconomic Status ◽

Breast Reconstruction ◽

Cancer Treatment ◽

Linked Data ◽

Breast Cancer Treatment ◽

Competing Risk ◽

Advanced Stage ◽

Lower Socioeconomic ◽

Cancer Plan

Abstract Introduction Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Methods A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan–Meier product-limit estimates and multivariate competing risk regression. Results Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival. Conclusion This study provides benchmarks for monitoring future variations in treatment and survival.

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Pattern of Presentation of Mammography in a Developing Country

Nepalese Journal of Radiology ◽

10.3126/njr.v10i2.35974 ◽

2020 ◽

Vol 10 (2) ◽

pp. 33-37

Author(s):

Birendra Raj Joshi

Keyword(s):

Breast Cancer ◽

Developing Country ◽

Tertiary Hospital ◽

Dense Breast ◽

Advanced Stage ◽

Cancer Death ◽

Convenience Sampling

Introduction: Breast cancer is the second commonest cancer (7.2%) in Nepal and almost 54%of patients present in the advanced stage. It is the leading cause of cancer death in females.The objective of the study was to determine the type of mammography, composition of breastdensity and BIRADS category.Methods: The study was conducted in a tertiary hospital from Jan 1st to Oct 30th of 2019according to non-probability convenience sampling. A total of 388 persons were included inthe study. The mammographic findings were assessed by categories based on the BIRADSsystem.Results: Mammography for screening was 38 percent and diagnostic was 68 percent. Commonbreast compositions were B and C. More frequent BIRADS categories were seen in 1 and 2.Conclusion: Dense breast is common in mammography. BIRADS categories 1 and 2 weremore common than other categories.

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