Higher tamoxifen use as chemoprophylaxis in patients with ductal carcinoma in situ (DCIS) in the last decade.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 191-191
Author(s):  
Erin E. Roesch ◽  
Lai Wei ◽  
Bhuvaneswari Ramaswamy
Keyword(s):  
Hormone Therapy ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Breast Conserving Surgery ◽  
The United States ◽  
Recurrence Rates ◽  
Chi Square ◽  
Significant Difference

191 Background: The incidence of DCIS over the last two decades has increased, with over 62,000 new cases diagnosed annually in the United States. Tailored management of DCIS is still a work in progress and currently treatment options are varied. We sought to identify changes in patterns of care in individual and physician choices for surgery and chemoprophylaxis over the last two decades at our institution. Methods: We performed a retrospective chart review and identified 773 eligible patients using the James Cancer Registry and the NCCN database at The Ohio State University between 1990 and 2010. We compared the proportion of patients undergoing mastectomy vs breast conserving surgery (BCT), use of radiation and hormone therapy, and recurrence rates between the years 1990-2000 and 2001-2010 using Chi-square test. Results: There was no significant difference in race (p=0.21) or age (p=0.09) among patients diagnosed with DCIS between 1990-2000 (Group A, N=462) and 2001-2010 (Group B, N=311). There was no significant difference in mastectomy rates between the two groups (31% vs. 27%, p= 0.26). Patients less than 50 years old were more likely to undergo mastectomy in both groups (p=0.02). Use of radiation therapy following BCT was similar between the two groups (52% vs. 53%, p=0.76). Interestingly more patients received hormone therapy during 2001-2010 than 1990-2000 (48% vs. 26%, p < 0.0001). Patients undergoing mastectomy were less likely to receive radiation (2% vs. 74%, p<0.0001) and hormone therapy (25% vs. 39%, p<0.0001). There was no significant correlation between race and type of surgery. We are in the process of comparing recurrence rates between the two groups which will be reported. Conclusions: Previously published studies have reported higher rates of mastectomy among patients with early stage breast cancer in the recent years. Data from our institution over the last two decades did not corroborate this finding, although interestingly we have found increasing use of tamoxifen therapy for DCIS in the second decade. Understanding current practices is helpful in designing future studies for management of DCIS using novel prognostic assays such as Oncotype Dx assay.

Decision Support for Women With Early Breast Cancer

2015 ◽  
Vol 8 (2) ◽  
pp. 222-230
Author(s):  
Mary K. Donnelly-Strozzo ◽  
Anne Belcher
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Breast Cancer ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Treatment Options ◽  
The United States ◽  
Practice Change ◽  
Decision Control ◽  
Significant Difference

Approximately 100,000 new cases of lymph node–negative, estrogen receptor–positive breast cancer are diagnosed each year in the United States (Jemal et al., 2007). Adjuvant treatment for these patients is recommended and may include chemotherapy, hormonal therapy, combined chemotherapy plus hormonal therapy, or observation alone. Patient uncertainty plus dissatisfaction with the level of decision-making control over treatment options is common. This evidence-based practice change project focuses on improving the decision-making confidence of women with early stage breast cancer by increasing active participation in the discussion of treatment options. Seven participants’ decision control preferences were determined using a Control Preferences Scale. The effect of this intervention on satisfaction with the process was evaluated by using a 6-question Satisfaction With Decision instrument. There was a significant difference p < .05 in satisfaction with the decision process using a 2-tailed t test. This test was used to evaluate the effect of the intervention on satisfaction with the decision-making process compared to a group of women who did not receive the intervention. Women with early breast cancer can benefit from nursing interventions targeted at supporting their preferred level of decision control when making decision regarding treatment choices.

scholarly journals Retrospective Chart Review Comparing CKD COVID-19 Positive Patient Outcomes to non-CKD Patient Outcomes

2020 ◽  
Vol 3 ◽  
Author(s):  
Nicole Eckert ◽  
Safiya Sankari ◽  
Katie Allen ◽  
Siu Lui Hui ◽  
Eneida Mendonca
Keyword(s):  
Patient Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Inpatient Admission ◽  
Control Group ◽  
Chi Square ◽  
Visitation Rates ◽  
Significant Difference ◽  
Chi Square Test

Background/Objective:  Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD.     Methods:   This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes.       Results:  The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p<0.05) in all clinical outcomes tested of CKD patients diagnosed with COVID-19 compared to non-CKD patients. The CKD population had increased mortality, inpatient admission, and ED visitation rates when compared.     Discussion:  This study demonstrates that comorbidities, more specifically CKD, may be associated with a higher severity of COVID-19 than those without. Future studies are needed to explore the relationship more extensively, analyze other outcomes, and manage confounding variables.  

scholarly journals Ductal Carcinoma In Situ of the Breast

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Richard J. Lee ◽  
Laura A. Vallow ◽  
Sarah A. McLaughlin ◽  
Katherine S. Tzou ◽  
Stephanie L. Hines ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Partial Breast Irradiation ◽  
Significant Shift

Ductal carcinoma in situ (DCIS) of the breast represents a complex, heterogeneous pathologic condition in which malignant epithelial cells are confined within the ducts of the breast without evidence of invasion. The increased use of screening mammography has led to a significant shift in the diagnosis of DCIS, accounting for approximately 27% of all newly diagnosed cases of breast cancer in 2011, with an overall increase in incidence. As the incidence of DCIS increases, the treatment options continue to evolve. Consistent pathologic evaluation is crucial in optimizing treatment recommendations. Surgical treatment options include breast-conserving surgery (BCS) and mastectomy. Postoperative radiation therapy in combination with breast-conserving surgery is considered the standard of care with demonstrated decrease in local recurrence with the addition of radiation therapy. The role of endocrine therapy is currently being evaluated. The optimization of diagnostic imaging, treatment with regard to pathological risk assessment, and the role of partial breast irradiation continue to evolve.

scholarly journals Reoperation costs in attempted breast-conserving surgery: a decision analysis

2016 ◽  
Vol 23 (5) ◽  
pp. 314 ◽  
Author(s):  
R. Pataky ◽  
C.R. Baliski
Keyword(s):  
Health Care ◽  
Breast Reconstruction ◽  
Patient Care ◽  
Health Care System ◽  
Early Stage ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Reoperation Rate ◽  
The Cost ◽  
Care System

Background Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after bcs, and the effect that a reduction in the reoperation rate could have on the B.C. health care system.Methods A decision tree was constructed to estimate the average cost per patient undergoing initial bcs with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy.Results Costs ranged from a low of $8,225 per patient with definitive bcs [95% confidence interval (ci): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% ci: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted bcs (95% ci: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually.Summary The implementation of initiatives to reduce reoperation after bcs could result in significant savings to the health care system, while potentially improving the quality of patient care.

scholarly journals Descriptive analysis of 192 cases of breast cancer occurring before age 40 in Yaounde, Cameroon

2017 ◽  
Vol 6 (7) ◽  
pp. 2704 ◽  
Author(s):  
Félix Essiben ◽  
Pascal Foumane ◽  
Esther JNU Meka ◽  
Michèle Tchakounté ◽  
Julius Sama Dohbit ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Descriptive Analysis ◽  
Survival Rates ◽  
The United States ◽  
Therapeutic Modalities ◽  
History Of ◽  
Case Files ◽  
Common Histological Type

Background: Breast cancer is today a global health problem. With 1,671,149 new cases diagnosed in 2012, it is the most common female cancer in the world and accounts for 11.9% of all cancers and it affects more people than prostate cancer. In 2008, The United States statistics showed that, for all cancer that affect women before 40 years, more than 40% of them concerned the breast. The aim of this study was to describe the clinical, histopathological and therapeutic aspects of breast cancer in women under 40 years of age in Yaoundé.Methods: This was a retrospective study with data collected from 192 medical case files of women treated over a period of 12 years, from January 2004 to December 2015 at the Yaounde General Hospital and the Yaounde Gyneco-Obstetric and Pediatric Hospital. Microsoft Epi Info version 3.4.5 and SPSS version 20.0 softwares were used for data analysis.Results: From 2004 to 2015, 1489 cases of breast cancer were treated in both hospitals. Of these, 462 women were less than 40 years old, representing a proportion of 31.0%. The mean age at diagnosis was 33.5±5.0 years and 17.7% of women had a family history of breast cancer. The average time before an initial consultation was 6.7±6.6 months.  Most cases were classified as T4 (46.1%). The most common histological type was ductal carcinoma (87.4%). Grades SBR II and SBR III were predominant (76.4%). Axillary dissection (64.4%) and neoadjuvant chemotherapy (43.9%) were the main therapeutic modalities. The overall survival rate at 5 years was 51.2%. Five-year survival rates with no local recurrence and no metastatic occurrence were 35.8% and 43.2% respectively.Conclusions: Breast cancer largely affects women under the age of 40 and is often discovered late, at an advanced stage. The prognosis appears poor. Only screening could facilitate diagnosis at an early stage of the disease for better outcomes.

An Analysis of Unmanned Aircraft Registration Effectiveness

2017 ◽  
Vol 4 (1) ◽  
pp. 54-66
Author(s):  
Ronald Pentz ◽  
He (Herman) Tang
Keyword(s):  
United States ◽  
Statistical Analysis ◽  
The United States ◽  
Unmanned Aircraft ◽  
Unmanned Aircraft Systems ◽  
Courts Of Appeals ◽  
Chi Square ◽  
Difficult Time ◽  
Significant Difference ◽  
Rapid Pace

This article describes how small unmanned aircraft systems (sUAS) are growing at a rapid pace. They are inexpensive and widely available for both hobbyist and commercial use. However, with this rapid growth, regulations are having a difficult time keeping pace to safely incorporate them into the United States National Airspace. Recent regulations requiring the registration of all sUAS have been overturned by the United States Courts of Appeals. This research provides a statistical analysis of the effectiveness of the registration regulation in the reduction of unauthorized and careless sUAS operation prior to being overturned by the courts. Statistical analysis including descriptive statistics and chi square hypothesis tests were used to analyze more than 3,000 reported unauthorized and careless events. The findings show a significant difference in events pre-registration and post registration.

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 1239. Efficacy of Preoperative Chlorhexidine Gluconate and Mupirocin in the Prevention of Orthopedic Surgical Site Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S446-S446
Author(s):  
Gabrielle Kahler ◽  
Michael Ing
Keyword(s):  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
The United States ◽  
Chlorhexidine Gluconate ◽  
Orthopedic Procedures ◽  
Causative Organism ◽  
Infection Rates ◽  
Chi Square ◽  
Increased Risk

Abstract Background Surgical site infections (SSIs) affect 1–5% of patients undergoing surgical procedures in the United States each year and have a mortality rate of up to 75%. We sought to assess the efficacy of a bundled preoperative decolonization treatment protocol to prevent SSIs in hip, knee, or spine procedures. Methods A retrospective chart review was conducted for 2224 adult patients undergoing spine, knee, or hip procedures performed at the JL Pettis Memorial VAMC from October 1, 2010 to December 31, 2018. NHSN/CDC criteria were utilized. The study included spine surgeries with or without new hardware, but only hip and knee surgeries with new hardware. Procedures with an infection present at the time of surgery (PATOS) were excluded. A pre-operative methicillin-resistant Staphylococcus aureus (MRSA) nares screen was performed. Patients treated were given mupirocin (MPN) to apply to their nares and 4% chlorhexidine gluconate (CHG) to wash all skin prior to the procedure. Patients undergoing emergent procedures received CHG without MPN. The intention to treat model and chi-square test were utilized. The primary endpoints were the infection rates in both the untreated and treated groups. Secondary endpoints included the MRSA screening result, SSI class, causative organism(s), and the surgical site. Results A total of 2,112 procedures were included in the study. Thirty-three (1.56%) procedures met NHSN/CDC criteria for SSI. Of the 1,754 (83.0%) procedures given decolonization treatment with MPN and/or CHG, 22 (1.25%) developed an SSI. Of the 358 procedures not receiving treatment, 11 (3.07%) developed an SSI. Conclusion Patients given decolonization treatment had a lower infection rate compared with those who were not treated (1.25% vs. 3.07%, P = 0.0115). Even though the decrease in infection rates were most significant for hip procedures, the overall trend favored the use of a preoperative decolonization treatment protocol for all of the orthopedic procedures studied (Table 1). Current barriers include patient compliance and correct use of decolonization agents, which may affect the actual efficacy of decolonization treatment. A possible confounder was the known increased risk of SSIs in emergent procedures. Disclosures All authors: No reported disclosures.

A misperceived threat: Understanding the increasing mastectomy rates.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 75-75
Author(s):  
Andrea Marie Covelli ◽  
Nancy N. Baxter ◽  
Margaret Fitch ◽  
Frances Catriona Wright
Keyword(s):  
Decision Making ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Treatment Options ◽  
Contralateral Prophylactic Mastectomy ◽  
The United States ◽  
Breast Conserving Therapy ◽  
Average Risk ◽  
Sources Of Information ◽  
Structured Interviews

75 Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early-stage breast cancer (ESBC) have been increasing. Both surgeons’ preference and patients’ choice have been suggested to play a role. Methods: A qualitative study was conducted examining surgeon’s practices and patient’s decision-making during treatment for ESBC. The Health-Belief Model was applied identifying factors influential in the choice for UM+/-CPM. Purposive sampling identified non-high-risk women across Toronto, Canada who were candidates for breast conserving therapy (BCT) but underwent UM+/-CPM. Academic and community breast surgeons from across Ontario, Canada and the United States were also recruited. Data were collected through semi-structured interviews. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons were interviewed. The dominant theme was the ‘misperceived threat of ESBC: an overestimated risk’. Surgeons described the high survivability of ESBC, yet patients greatly overestimated the threat of death from their cancer and strived to eliminate this threat by choosing UM+/-CPM. Surgeons described BCT and UM as equivalent treatment options for ESBC, and recommended BCT. In this average-risk population CPM was discouraged by the surgeons describing no survival advantage; despite this, women requested UM+CPM. Personal cancer experiences with family and friends were extremely influential in women’s request for UM+/-CPM. Previous negative experiences translated into an overestimated risk of recurrence, contralateral cancer, metastasisand subsequent death. Patients’ misperceived the severity of ESBC, and believed that by choosing UM+/-CPM they would live longer. Most women did not perceive any risks of undergoing mastectomy, yet many had ongoing issues with skin sensation, cosmesis and body image. Conclusions: Despite surgeons counseling otherwise, women greatly overestimated the risk of ESBC and misperceived the benefits of mastectomy. As undergoing UM+/-CPM is not without risks, improved discussion of patient sources of information and fears around survival may benefit surgical consultations, facilitating informed decision-making.

Breast cancer care redesign as an approach to streamline survivorship care: Outcomes and challenges.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 9-9
Author(s):  
Kathryn Elizabeth Post ◽  
Barbara L. Smith ◽  
Alphonse G. Taghian ◽  
Steven J. Isakoff ◽  
Jeffrey M. Peppercorn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multidisciplinary Team ◽  
Early Stage ◽  
Significant Proportion ◽  
Retrospective Chart Review ◽  
The United States ◽  
Post Treatment ◽  
Trial Participation ◽  
Clinical Concern

9 Background: Optimal follow up care for the 3.1 million breast cancer (BC) survivors in the United States has not been definitively determined. ASCO and NCCN recommend that early stage BC patients have a history and physical by their oncology or primary care provider every 3 to 6 months in the first three years post treatment. Additional visits have not been shown to improve outcomes. However, many patients are seen more frequently, leading to increased healthcare costs. In this context, we developed and implemented a BC care redesign algorithm (BCCRA) to reduce redundant follow up. Methods: The BCCRA multidisciplinary team recommended BC survivors be seen by an oncology provider every 6 months for the first five years post treatment and annually thereafter. Retrospective chart review was conducted to evaluate BCCRA adherence from November 2014 to November of 2015. Patients were deemed ineligible if there was a medically necessary reason for visits outside of the BCCRA such as reconstruction, ongoing treatment or clinical trial participation. Eligible charts were analyzed for adherence. For survivors who did not adhere, charts were analyzed for outcome of additional visits. Results: 116 patient charts reviewed and 72 (62.1%) were deemed ineligible. Of the remaining 44 survivors, 26 (59.1 %) adhered and 18 (40.91%) did not adhere. Of the 18 survivors who did not adhere, six had visits due to clinical concern and 12 had visits due to patient or provider preference. Of the 6 patients who had visits for clinical concern, 4 resulted in a change in the patient’s medical management (CMM). Of the 12 patients who had visits due to patient/provider preference, 2 resulted in a CMM. Conclusions: Despite buy-in from a motivated multidisciplinary team, there were challenges to implementing the BCCRA. 62.1% of patients were ineligible and there was a significant proportion of patients/providers who chose more frequent visit schedules. However, the BCCRA had 59.1% adherence which could result in cost reduction and increased flexibility in oncologists’ schedules. Further evaluation of the model is needed to validate these claims.

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