Patient-provider communication during post-treatment breast cancer care: Findings from a pilot project.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 91-91 ◽  
Author(s):  
Neetu Chawla ◽  
Michael Sanchez ◽  
Jayson Harpster ◽  
Leslie Manace Brenman ◽  
Raymond Liu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Pilot Project ◽  
Post Treatment ◽  
Social Needs ◽  
Provider Communication ◽  
Breast Cancer Patients ◽  
Patient Centered ◽  
Treatment Side Effects ◽  
Patient Provider Communication

91 Background: Patient-provider communication is essential to delivering high quality cancer care, including post-treatment when survivors have many complex care needs. In this study, we used data collected for quality improvement from a small, feasibility sample to examine patient perceptions of provider communication and inform the development of a new Oncology Survivorship Clinic model. Methods: As part of a pilot project conducted at Kaiser Permanente Northern California (KPNC), we surveyed 51 breast cancer patients post-treatment. The survey included a communication measure from the 2011 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer survey evaluating provider discussions of: surveillance for recurrence; late or long-term treatment effects; healthy lifestyle behaviors; and emotional or social needs. We also examined reports of the six core functions of patient-centered communication (i.e. managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information) using a measure from the Health Information Trends Survey (HINTS) survey. Part of the purpose was to evaluate acceptability of a new Oncology Survivorship Clinic utilizing non-physician providers. Results: The sample included 51 breast cancer patients surveyed in 2016 within six months of treatment completion. Overall, sizable proportions received detailed communication about surveillance (65%), treatment side effects (46%), emotional needs (41%), and healthy lifestyles (71%) and the majority received patient-centered communication (range: 60-73% based on core function). Particular gaps were noted related to provider communication about treatment side effects (54%), emotional/social needs (59%), managing uncertainty (35%), and responding to emotions (40%). Conclusions: Our very preliminary findings suggest that the majority of women had positive communication experiences, including with non-physician providers. However, clear communications gaps existed underscoring future avenues for research and care delivery interventions to address the comprehensive needs of breast cancer patients.

scholarly journals Racial and Ethnic Disparities in Patient-Provider Communication With Breast Cancer Patients: Evidence From 2011 MEPS and Experiences With Cancer Supplement

2017 ◽  
Vol 54 ◽  
pp. 004695801772710 ◽  
Author(s):  
Shelley I. White-Means ◽  
Ahmad Reshad Osmani
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ethnic Disparities ◽  
Medical Expenditure ◽  
Provider Communication ◽  
Breast Cancer Patients ◽  
Patient Provider Communication ◽  
Race Ethnicity ◽  
The Relationship

The current study explores racial/ethnic disparities in the quality of patient-provider communication during treatment, among breast cancer patients. A unique data set, Medical Expenditure Panel Survey and Experiences With Cancer Supplement 2011, is used to examine this topic. Using measures of the quality of patient-provider communication that patients are best qualified to evaluate, we explore the relationship between race/ethnicity and patients’ perspectives on whether (1) patient-provider interactions are respectful, (2) providers are listening to patients, (3) providers provide adequate explanations of outcomes and treatment, and (4) providers spend adequate time in interacting with the patients. We also examine the relationship between race/ethnicity and patients’ perspectives on whether their (1) doctor ever discussed need for regular follow-up care and monitoring after completing treatment, (2) doctor ever discussed long-term side effects of cancer treatment, (3) doctor ever discussed emotional or social needs related to cancer, and (4) doctor ever discussed lifestyle or health recommendations. Multivariate ordinary least squares and ordered logistic regression models indicate that after controlling for factors such as income and health insurance coverage, the quality of patient-provider communication with breast cancer patients varies by race/ethnicity. Non-Hispanic blacks experience the greatest communication deficit. Our findings can inform the content of future strategies to reduce disparities.

Geriatric screening of older breast cancer patients – a pilot project

2011 ◽  
Vol 71 (08) ◽  
Author(s):  
K Hancke ◽  
M Hasch ◽  
A Gerstenmayr ◽  
T Nikolaus ◽  
R Kreienberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Pilot Project ◽  
Breast Cancer Patients ◽  
Geriatric Screening

scholarly journals PCN30 Treatment Patterns and Outcomes of Breast Cancer Patients in a Patient-Centered Retrospective Research Registry

2012 ◽  
Vol 15 (7) ◽  
pp. A414
Author(s):  
S. Saokaew ◽  
B. Cai ◽  
K.L. Kuo ◽  
H. Bauer ◽  
F. Albright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Treatment Patterns ◽  
Breast Cancer Patients ◽  
Patient Centered

Immunomodulatory Activities of Yunzhi and Danshen in Post-treatment Breast Cancer Patients

2005 ◽  
Vol 33 (03) ◽  
pp. 381-395 ◽  
Author(s):  
Chun-Kwok Wong ◽  
Yi-Xi Bao ◽  
Eliza Lai-Yi Wong ◽  
Ping-Chung Leung ◽  
Kwok Pui Fung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Weight ◽  
Cancer Patients ◽  
Salvia Miltiorrhiza ◽  
Interleukin 2 ◽  
Post Treatment ◽  
Enzyme Linked Immunosorbent Assay ◽  
Breast Cancer Patients ◽  
T Helper ◽  
The Absolute

Breast cancer is the most common cancer among women worldwide. Discomfort and fatigue are usually arisen from anticancer therapy such as surgery, radiotherapy, chemotherapy, hormonal therapy, or combination therapy, because of the suppressed immunological functions. Yunzhi (Coriolus versicolor) can modulate various immunological functions in vitro, in vivo, and in human clinical trials. Danshen (Salvia miltiorrhiza) has been shown to benefit the circulatory system by its vasodilating and anti-dementia activity. The purpose of this clinical trial was to evaluate the immunomodulatory effects of Yunzhi-Danshen capsules in post-treatment breast cancer patients. Eighty-two patients with breast cancer were recruited to take Yunzhi [50 mg/kg body weight, 100% polysaccharopeptide (PSP)] and Danshen (20 mg/kg body weight) capsules every day for a total of 6 months. EDTA blood samples were collected every 2 months for the investigation of immunological functions. Flow cytometry was used to assess the percentages and absolute counts of human lymphocyte subsets in whole blood. Plasma level of soluble interleukin-2 receptor (sIL-2R) was measured by enzyme-linked immunosorbent assay (ELISA). Results showed that the absolute counts of T-helper lymphocytes (CD4+), the ratio of T-helper (CD4+)/T suppressor and cytotoxic lymphocytes (CD8+), and the percentage and the absolute counts of B-lymphocytes were significantly elevated in patients with breast cancer after taking Yunzhi-Danshen capsules, while plasma sIL-2R concentration was significantly decreased (all p < 0.05). Therefore, the regular oral consumption of Yunzhi-Danshen capsules could be beneficial for promoting immunological function in post-treatment of breast cancer patients.

Measurement of DKK1 and FRP in breast and prostate cancer patients with bone metastases: Impact of zoledronic acid (ZA)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19659-19659
Author(s):  
T. Helsten ◽  
M. Corr ◽  
J. E. Mortimer
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Post Treatment ◽  
Bone Homeostasis ◽  
Breast Cancer Patients ◽  
Bone Specific Alkaline Phosphatase ◽  
Osteoblast Activity ◽  
Breast And Prostate Cancer

19659 Background: Bone metastases produce an imbalance in osteoblast and osteoclast activity. While metastases from prostate cancer are osteoblastic, metastases from breast cancer may be osteolytic, osteoblastic or mixed. The wnt/frizzled pathway is involved in maturation of osteoblasts and in adult bone homeostasis. We explored the wnt antagonists dickkopf (DKK1) and frizzled related protein (FRP) as potential biomarkers in bone metastasis after ZA treatment. Methods: This is a pilot cohort study in bisphosphonate naive breast and prostate cancer patients with bone metastases. Cancer therapy was not specified. Patients received 2 monthly doses of ZA 4 mg IV. Pre- and post-treatment (day 60) sera were collected for measurement of FRP and DKK1, along with IL-6, calcium, creatinine and bone-specific alkaline phosphatase (BAP, a marker of osteoblast activity). Primary endpoint: mean change in FRP and DKK1; Secondary endpoints: correlation of biomarkers with each other and comparison of breast vs. prostate cancer patients. Biomarkers were measured using standard ELISA assays. Statistics: comparison of means = student t-test, correlation coefficients = Pearson. Results: Mature data from 14 patients are reported here, 9 with breast and 5 with prostate cancer. Mean age = 61 years (range 42–89). Two breast cancer patients were premenopausal. One prostate and 3 breast cancer patients received chemotherapy; all others were treated hormonally. After ZA, calcium decreased in all patients (p = 0.09). BAP decreased in all but 1 breast and 1 prostate cancer patient (mean decrease 20.0, p = 0.16). IL-6 was undetectable in most patients. FRP decreased in all but 4 patients (mean decrease 6.2, p = 0.13). There was no discernable pattern for DKK1. Pre-treatment DKK1 correlated with FRP (p = 0.01, r2 = 0.39), but there was no correlation post-treatment. Post-treatment DKK1 correlated with both serum calcium (p = 0.04, r2 = 0.49) and BAP (p = 0.005, r2 = 0.65). There was no difference between breast and prostate cancer patients. Conclusions: It is feasible to measure DKK1 and FRP in patients with malignant bone disease. Treatment with ZA has measurable effects upon these and other serum markers. Further studies with more patients are needed to evaluate their potential as biomarkers. No significant financial relationships to disclose.

Physician age and surveillance intensity following curative-intent treatment for breast cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6081-6081
Author(s):  
Steven F. Abboud ◽  
Emad S. Allam ◽  
Julie A. Margenthaler ◽  
Ling Chen ◽  
Katherine S. Virgo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Liver Function Tests ◽  
Post Treatment ◽  
Breast Cancer Patients ◽  
Curative Intent ◽  
Clinical Vignettes ◽  
Serum Cea ◽  
The Difference ◽  
Surveillance Practice

6081 Background: Breast carcinoma is a large health care concern for patients, physicians, and society. 2.5 million women have been treated for breast cancer and are candidates for surveillance in the US. We have documented dramatic variation in post-treatment surveillance strategies utilized by ASCO experts caring for such patients. Since it is often asserted that younger physicians order more tests than older physicians, we sought to measure the effect of clinician age on post-treatment surveillance intensity for breast cancer patients by analyzing a recent survey of ASCO members. Methods: We surveyed the 3245 ASCO members who indicated that breast cancer treatment was a major focus of their practice. 4 succinct clinical vignettes describing generally healthy women with breast cancer of varying prognoses and a menu of 12 surveillance modalities were offered. The menu was chosen after a literature search indicated that no other surveillance tests were commonly used. We analyzed data from one of the 4 idealized vignettes only (the patient with TNM IIA carcinoma) and stratified responses by clinician age. Practice patterns were compared by years after completion of training (0-10, 11-20, 21-30, 30-40, >40 years), a surrogate measure of physician age. Statistical analysis employed ANOVA. Results: There were 1012 responses; 915 were evaluable. Statistically significant differences were observed across age strata for CBC, liver function tests (LFTs), and serum CEA level only. For example, ASCO clinicians in practice for 0-10 years after completion of training recommended CBCs 1.3 + 1.4 (mean + SD) times in year 1. Those > 40 years after completion of training recommended CBCs 2.4 + 1.3 times in year 1 (p<0.001). Conclusions: Younger physicians recommend statistically significantly fewer CBCs, LFTs, and serum CEA levels during post-treatment surveillance than older physicians. However, the magnitude of the difference is clinically small for all 3 modalities and does not explain the known overall variation in surveillance practice among clinically active experts.

Electrochemotherapy for cutaneous metastases in breast cancer: Experience from a designated treatment centre.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 48-48
Author(s):  
Shramana Mitul Banerjee ◽  
Jackie Newby ◽  
Shahab Khan ◽  
Virginia Homfray ◽  
Diane Whittaker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Disease Progression ◽  
Cancer Patients ◽  
Chest Wall ◽  
Chemotherapeutic Agents ◽  
Post Treatment ◽  
Breast Cancer Patients ◽  
Cutaneous Metastases ◽  
Treatment Centre

48 Background: Electrochemotherapy (ECT) combines the administration of poorly permeable chemotherapeutic agents with electroporation. It has been shown to be effective when compared with other treatments. This study assessed how breast cancer patients were benefited and identified potential problems at a designated treatment centre. Methods: This was a single centre prospective study of patients with cutaneous metastases from breast cancer. Patients who fulfilled NICE UK (National Institute Of Clinical Excellence) and local guidelines were treated. Gabapentin was given prior to general anaesthesia. Intravenous Bleomycin 15,000IU/m2 was given as a bolus. Treatment was commenced 8 minutes later with Cliniporator. Electrical pulses were delivered via an electrode inserted through the skin surface. Treatment response, disease progression free duration, post-operative pain and length of in-patient stay (LOS) were recorded. Patients recorded a symptom diary post treatment. Results: 20 treatments were performed in 16 patients from 2011-2015 with 53 separate areas treated. 8 patients had diffuse lesions, 5 had discrete lesions and 3 had both diffuse and discrete areas. 16 patients were being treated with ECT for the first time and 4 patients required 2 treatments. Median LOS was 3 days. Median follow up was 6 months (range 3-12).12 patients had complete response (75%) and 4 patients partial response. There was no disease progression for 6 months or more in 9 patients (56%) and 2 further patients had disease stabilised for 3 months with systemic or cutaneous progression in the remaining patients in 3 months or less. There were no deaths or immediate adverse events from ECT. 5 Patients (31%) with extensive diffuse chest wall disease reported persistent discomfort post treatment requiring extended period of post treatment analgesia. Conclusions: Electrochemotherapy is safe and effective treatment for cutaneous metastases. Appropriate patient selection for treatment, pre-emptive analgesia, post treatment support and follow up is essential in order to maximise the benefits and minimise potential side-effects particularly in extensive chest wall disease.

Using Canadian administrative data to evaluate primary and oncology care of breast cancer patients post-treatment: Subset of the CanIMPACT Study.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 5-5 ◽  
Author(s):  
Mary L McBride ◽  
Patti Groome ◽  
Donna Turner ◽  
Margaret Jorgensen ◽  
Cynthia Kendell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Administrative Data ◽  
Cancer Care ◽  
Data Access ◽  
Post Treatment ◽  
Breast Cancer Patients ◽  
Oncology Care

5 Background: CanIMPACT is a multi-provincial Canadian research team funded to identify and address key issues faced by cancer patients and providers at the intersection of primary and specialist oncology care. Canada has national healthcare standards, but provincial/territorial healthcare delivery systems. One facet will use administrative data from the population-based, publicly-funded healthcare system to evaluate issues during pre-diagnosis, treatment, and post-treatment survivorship for breast cancer patients. For the survivorship phase, we aim to conduct the following analyses and compare across provinces: 1) Utilization of physician services overall and by specialty, including oncologists, non-oncology specialists, and primary care; 2) Assessment of adherence to ASCO and Canadian follow-up guideline for breast cancer care, use of surveillance breast imaging, and metastatic investigations; 3) Assessment of adherence to recommended care of chronic illness and preventive care; 4) Quantification of the cost of follow-up overall and by specialty; 5) Comparison of inter- and intra-provincial variation for all outcomes by health administrative region and for vulnerable groups (age ≥ 75 at diagnosis, northern/rural/remote, low income, immigrants), and examine the effect of continuity of primary care and chronic disease on post-treatment care. Methods: Patients will be identified from provincial cancer registries and linked to data extracted from: outpatient physician service claims, hospital inpatient and outpatient data, and cancer facility medical records. Results: Participating provinces have finalized the core questions and detailed protocols, and assessed data comparability. They are in the process of obtaining the required ethics and data access approvals, and data acquisition for processing and analysis. Conclusions: Results will address existing information gaps that can be used to improve transition and care across the cancer care trajectory. Importantly, results will be combined with those of a CanIMPACT qualitative study to inform design of a pragmatic randomized trial focused on improving coordination and quality of care.

Serum metabolism during breast cancer treatment.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23043-e23043
Author(s):  
Guro Fanneløb Giskeødegård ◽  
Torfinn Støve Madssen ◽  
Riyas Vettukattil ◽  
Vidar Gordon Flote ◽  
Anders Husøy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Weight Gain ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Breast Cancer Treatment ◽  
Post Treatment ◽  
Breast Cancer Patients ◽  
National Guidelines ◽  
Lipoprotein Subfractions ◽  
Metabolite Profiles

e23043 Serum metabolism during breast cancer treatment Background: Breast cancer treatment may include surgery, systemic therapy and radiation, often involving side-effects. Many patients experience weight gain during treatment, which is associated with decreased survival rates1. The purpose of this study was to describe serum metabolic alterations in breast cancer patients undergoing treatment, and relate these alterations to weight gain during treatment. Methods: This pilot study includes 60 breast cancer patients, aged 35-75 years, with histologically verified stage I/II disease. All patients underwent tumor surgery, and were treated according to national guidelines. Samples were collected before and 6 months after surgery, and analyzed by MR spectroscopy (MRS) and mass spectrometry (MS). 170 metabolites and 105 lipoprotein subfractions were quantified by combined MRS and MS analyses. Results: Multilevel PLS-DA showed significant alterations in serum metabolite profiles post-treatment, both in patients receiving (n = 35) and not receiving (n = 25) chemotherapy (classification accuracy: 86.7% and 77.0%, resp., p < 0.001). Lipoprotein profiles were also significantly altered in both groups (p < 0.001). Chemotherapy recipients had decreased levels of citrate, ornithine, and methionine after treatment, while non-recipients had increased levels of glutamate, alanine, proline and two biogenic amines, and decreased levels of acylcarnitines. 17/52 patients (32.7%) gained weight (≥ 1.5 kg) during treatment. Weight gain was predicted from pre-treatment samples with accuracy 67.0% (p = 0.020). Weight gain patients had lower levels of three acylcarnitines and 20 phosphocholines, and higher levels of lysine and isoleucine, suggesting aberrant lipid and amino acid metabolism. Weight gain was also reflected in the post-treatment samples (accuracy 66.8%, p = 0.015), with weight gain patients having higher levels of five acylcarnitines, and lower levels of glycine, isoleucine and valine. Conclusions: This study indicates that treatment induces changes in serum metabolite levels. Patients gaining weight had significantly different metabolite profiles than those not gaining weight both before and after treatment. 1. Chan et al, Ann Oncol 25: 1901-14, 2014.

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