Mastectomy or Lumpectomy? Helping Women Make Informed Choices

1999 ◽  
Vol 17 (6) ◽  
pp. 1727-1727 ◽  
Author(s):  
Timothy Whelan ◽  
Mark Levine ◽  
Amiram Gafni ◽  
Kenneth Sanders ◽  
Andrew Willan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Clinical Stage ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Average Score ◽  
Simple Method ◽  
The Impact ◽  
Decision Board

PURPOSE: To develop an instrument to help clinicians inform their patients about surgical treatment options for the treatment of breast cancer and to evaluate the impact of the instrument on the clinical encounter. METHODS: We developed an instrument, called the Decision Board, to present information regarding the benefits and risks of breast-conserving therapy (lumpectomy plus radiation therapy) and mastectomy to women with early-stage breast cancer to enable them to express a preference for the type of surgery. Seven surgeons from different communities in Ontario administered the instrument to women with newly diagnosed clinical stage I or II breast cancer over an 18-month period. Patients and surgeons were interviewed regarding acceptability of the instrument. The rates of breast-conserving surgery performed by surgeons before and after the introduction of the instrument were compared. RESULTS: The Decision Board was administered to 175 patients; 98% reported that the Decision Board was easy to understand, and 81% indicated that it helped them make a decision. The average score on a true/false test of comprehension was 11.8 of 14 (84%) (range, 6 to 14). Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations. The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% v 73%, P = .001) CONCLUSION: The Decision Board is a simple method to improve communication and facilitate shared decision making. It was well accepted by patients and surgeons and easily applied in the community.

scholarly journals Accelerated Partial Breast Irradiation as an Alternative to Whole-Breast Irradiation in Breast-Conserving Therapy for Early-Stage Breast Cancer

2005 ◽  
Vol 1 (1) ◽  
pp. 59-71
Author(s):  
Timothy M Pawlik ◽  
Henry M Kuerer
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Therapy ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

scholarly journals Surgical considerations for breast-conserving therapy in patients undergoing neoadjuvant chemotherapy for early-stage breast cancer

2005 ◽  
Vol 8 (2) ◽  
Author(s):  
G. V. Babiera
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Systemic Therapy ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Optimal Outcomes ◽  
Adjuvant Surgery

According to the National Cancer Comprehensive Network guidelines patients with breast tumours ≤1 cm should be offered systemic therapy. Multiple studies, however, have demonstrated no survival advantage between giving chemotherapy before (neoadjuvant) or after (adjuvant) surgery. There are, however, certain benefits that can be derived from patients who undergo neoadjuvant chemotherapy. Such benefits include better stratification of the patient's prognosis based on tumour and nodal response, and converting patients from mastectomy-only candidates to breast-conserving surgery candidates. Due to these advantages, many patients with early-stage breast cancer will undergo neoadjuvant chemotherapy and the surgical issues must be considered for patients who are treated in such a manner to guarantee optimal outcomes. Issues that will be discussed are the surgical preoperative evaluation, extent and timing of local resection of both the breast and regional nodes and finally, the potential future effects of this multi-modality therapy.

scholarly journals Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival

2010 ◽  
Vol 28 (12) ◽  
pp. 2038-2045 ◽  
Author(s):  
Mara A. Schonberg ◽  
Edward R. Marcantonio ◽  
Donglin Li ◽  
Rebecca A. Silliman ◽  
Long Ngo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Oldest Old ◽  
Age Groups ◽  
Breast Conserving Surgery ◽  
Stage I ◽  
Tumor Characteristics ◽  
Data Set ◽  
Younger Women ◽  
The Impact

Purpose Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. Patients and Methods We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, ≥ 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer–related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age ≥ 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age ≥ 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). Conclusion Women age ≥ 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.

Distance to nearest radiation facility and treatment choice in early stage breast cancer.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 73-73 ◽  
Author(s):  
Sahaja Acharya ◽  
Jeff M. Michalski ◽  
Stephanie Mabry Perkins
Keyword(s):  
Breast Cancer ◽  
Census Tract ◽  
Explanatory Variable ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Multivariate Logistic Regression ◽  
Explanatory Variables ◽  
N Stage

73 Background: Breast conserving surgery followed by breast radiation (RT), collectively termed breast conserving therapy (BCT), is a recommended alternative to mastectomy (MT) for early stage breast cancer. Limited access to RT may result in more extensive surgical treatment. The purpose of this study is to assess the association between distance to nearest RT facility and MT use in a modern cohort of BCT eligible women. Methods: Women with Stage 0 – II breast cancer eligible for BCT diagnosed from 2004 – 2010 were identified from a US state registry. Distance from patient census tract to nearest RT facility census tract was calculated. Multivariate logistic regression was used to identify explanatory variables that significantly influenced MT use, adjusting for age, poverty, insurance, race, Hispanic ethnicity, marital status, diagnosis year, distance to nearest RT facility, T stage, N stage, ER/PR status and grade. Results: Of the 24,994 eligible women, 25.4% (n = 6,346) underwent MT and 74.6% (n = 18,648) underwent a breast conserving surgery. 32% of patients lived in a census tract that was > 5 miles from a RT facility. MT use increased with increasing distance to RT facility (24.5% at ≤ 5 miles, 26.5% at > 5 to < 15 miles, 29.5% at 15 to < 40 miles and 43% at ≥ 40 miles, p < 0.001). The likelihood of MT was independently associated with increasing distance to RT facility (Odds Ratio [OR]: 1.02 for every mile increase, 95% Confidence Interval [CI]: 1.01 – 1.02, p < 0.001). Compared to patients living ≤ 5 miles away from a RT facility, patients living 15 - < 40 miles away were 1.3 times more likely to be treated with MT (OR: 1.31, 95% CI: 1.15 – 1.51, p < 0.001), and those living ≥ 40 miles away were more than twice as likely to be treated with MT (OR: 2.29, 95% CI: 1.51 – 3.45, p < 0.001). When restricting the sample to women with T1 disease (n = 16,656), distance to RT facility remained a significant explanatory variable for MT use on multivariate analysis (p < 0.001). Conclusions: MT use in a modern cohort of women eligible for BCT is independently associated with increasing distance to RT facility. Measures to improve RT access should be explored to ensure universal opportunity for BCT.

Impact of chemotherapy on health-related quality of life among ethnically diverse breast cancer survivors treated with breast-conserving therapy.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 237-237 ◽  
Author(s):  
Aseel Veronica Amora ◽  
Jessika Tano ◽  
Francisco A. Conde
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Systemic Chemotherapy ◽  
Early Stage ◽  
Public Awareness ◽  
Breast Conserving Therapy ◽  
The Impact

237 Background: Breast cancer (BC) is the most common cancer among women in the U.S. Public awareness and advances in BC screening have resulted in more women being diagnosed with early stage BC and treated with breast-conserving therapy (BCT) (lumpectomy followed by radiation therapy). Depending on prognostic factors and recurrence risk, systemic chemotherapy may be prescribed. Purpose of this study was to examine the impact of chemotherapy on quality of life (QOL) and needs of BC survivors treated with BCT for early stage BC. Methods: A list of 750 breast cancer survivors, aged 18 or older and who completed breast-conservation therapy for stages 0-II from 2001 - 2010, was obtained from a hospital’s tumor registry. Consent form and questionnaires, including a demographic questionnaire, City of Hope’s quality of life survey, and an investigator-developed questionnaire to assess for needs of cancer survivors, were mailed. T-test was used to compare mean subscales and overall QOL scores between those who received chemotherapy and those who did not. Frequencies and percentages were used to summarize the needs of BC survivors. Results: 119 completed surveys were received. Majority of respondents were Asians (56.3%), Caucasians (21.8%) and mixed ethnicity (13.4%). 55 patients received BCT plus systemic chemotherapy and 64 received BCT alone. Those who received systemic chemotherapy scored significantly lower on psychological subscale (p< 0.01), social subscale (p= 0.04), and overall QOL (p= 0.03) compared to survivors treated with BCT alone. Regarding needs, BC survivors want to learn about nutrition (40.3%), pain management (39.5%), improving memory (37.8%), and physical activity (33.6%). Conclusions: Although chemotherapy may decrease the risk of recurrence for early stage BC, lasting effects of treatment can negatively impact QOL. Understanding the impact of chemotherapy on various domains of QOL can be beneficial to patients and healthcare providers when discussing the risks and benefits of adjuvant systemic therapy. Further interventions are needed to improve QOL and address the needs among BC survivors treated with breast-conserving therapy.

Meeting the Decision-Making Preferences of Patients With Breast Cancer in Oncology Consultations: Impact on Decision-Related Outcomes

2012 ◽  
Vol 30 (8) ◽  
pp. 857-862 ◽  
Author(s):  
Richard Brown ◽  
Phyllis Butow ◽  
Maureen Wilson-Genderson ◽  
Juerg Bernhard ◽  
Karin Ribi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Decision ◽  
Preference Change ◽  
Treatment Decision Making ◽  
Decisional Control ◽  
Breast Cancer Study ◽  
The Impact

Purpose To investigate how involvement preferences of patients with breast cancer change during the treatment decision-making process and determine the impact of meeting patients' expectations on decision-making outcomes. Patients and Methods Participants were 683 patients with breast cancer from 62 oncologists in five different countries recruited to an International Breast Cancer Study Group (IBCSG 33-03) project. Questionnaires elicited patients' pre- and postconsultation preferences for involvement in treatment decision making and whether these were met or not. Decision-related outcomes were assessed postconsultation. Results Before the consultation, most patients preferred shared or patient-directed treatment decision making. After the consultation, 43% of patients' preferences changed, and most shifted toward patient-directed decisions. The actual postconsultation decision was more likely to be made according to postconsultation rather than preconsultation preferences. Compared with patients who were less involved than they had hoped to be, patients who were as involved as they had hoped to be or were even more involved in decision making had significantly better decision-related outcomes. This was true regardless of whether preference change occurred. Conclusion Many patients with early-stage breast cancer have treatment options and approach treatment decisions with a desire for decisional control, which may increase after their consultation. Patients' ultimate involvement preferences were more likely to be consistent with the way the decision was actually made, suggesting that patients need to feel concordance between their preference and the actual decision. Patients who directed decisions, even if more than they hoped for, fared better on all decision-related outcomes. These results emphasize the need for oncologists to endorse and facilitate patient participation in treatment decision making.

Decision Aids and Breast Cancer: Do They Influence Choice for Surgery and Knowledge of Treatment Options?

2007 ◽  
Vol 25 (9) ◽  
pp. 1067-1073 ◽  
Author(s):  
Jennifer F. Waljee ◽  
Mary A.M. Rogers ◽  
Amy K. Alderman
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Therapy ◽  
Early Stage ◽  
Decision Aids ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Decisional Conflict ◽  
Early Stage Breast Cancer ◽  
Patient Knowledge

Purpose To describe the effect of decision aids on the choice for surgery and knowledge of surgical therapy among women with early-stage breast cancer. Methods A systematic review was conducted between years 1966 to 2006 of all studies designed to assess the effect of decision aids on surgical therapy. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Network, HAPI databases, and bibliographies were searched. Of the 123 studies screened, 11 studies met criteria. Meta-analyses were performed to assess the pooled relative risk for surgical choice and the pooled mean difference in patient knowledge. Results Results from randomized controlled trials indicated that women who used a decision aid were 25% more likely to choose breast-conserving surgery over mastectomy (risk ratio, 1.25; 95% CI, 1.11 to 1.40). Decision aids significantly increased patient knowledge by 24% (P = .024). The data also suggested that decision aids decreased decisional conflict and increased satisfaction with the decision-making process. Decision aids were well received by surgeons and patients, facilitated patients’ desire for shared decision making, and were feasible to implement into practice. Conclusion Decision aids are important adjuncts for counseling women with early-stage breast cancer. Their use increases the likelihood that women will choose breast-conserving surgery, and enhances patient knowledge of treatment options.

Impact of utilization management policy on uptake of hypofractionated radiation in early-stage breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7015-7015
Author(s):  
Winnie Chi ◽  
Ravi Bharat Parikh ◽  
Ezra Fishman ◽  
Robert Paul Zimmerman ◽  
Atul Gupta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Management Policy ◽  
Administrative Claims ◽  
Adult Women ◽  
Utilization Management ◽  
Hypofractionated Radiation ◽  
The Impact

7015 Background: While hypofractionated radiation (HFR) after breast-conserving surgery is a cost-effective, patient-centered treatment in early-stage breast cancer (ESBC), less than 40% of eligible women received it in 2013. In 2016, a large commercial payer implemented a utilization management policy to encourage HFR for eligible women through denying reimbursement for extended-course radiation. We assessed the impact of the policy on HFR use and associated spending. Methods: We conducted a retrospective, adjusted difference-in-differences analysis using administrative claims of women continuously enrolled in 14 geographically diverse commercial health plans covering 6.9% of US adult women. The study population included women aged 18 or older with ESBC who were eligible for HFR according to 2011 guidelines from the American Society for Radiation Oncology. Women who received mastectomy, brachytherapy, or < 11 or > 40 external beam fractions were excluded. We compared HFR use and associated spending between women in fully-insured and Medicare Advantage (fully-insured) plans for whom the policy applied vs. self-insured or Medicare supplemental insurance (self-insured) plans for whom the policy did not apply. We adjusted for age, comorbidity, region, Medicare enrollment, and prior chemotherapy. Results: Among 10,540 eligible women, 3,619 (34%) were in fully insured plans and thus subject to the policy. There were no meaningful differences in mean age (63.8 vs. 65.0), Charlson comorbidity index (3.0 vs. 3.2), or practice setting between the fully-insured and self-insured groups. The policy was associated with an increase in HFR (4.2 adjusted percentage point difference-in-difference [ppd], 95% CI 0.0 to 8.4, p = 0.051) and a non-significant decrease in radiotherapy-associated expenditures (-$2,275, p = 0.09). Spillover analyses revealed significantly higher uptake of HFR among self-insured patients who were indirectly exposed to the policy through seeing the providers who also treated fulled insured women (8.5 adjusted ppd, 95% CI 3.6 to 13.5, p = 0.001), compared to those who were not exposed. Conclusions: A payer’s utilization management policy was associated with direct and spillover increases in HFR use, even after accounting for a strong secular trend towards increased hypofractionation use. However, policymakers must balance the impact of this and similar policies against their additional administrative costs.

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