Multidisciplinary conference to standardize survivorship care.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 17-17
Author(s):  
Beth Rudge ◽  
Megan Lanigan ◽  
Theresa M. Lee ◽  
Lisa Torp ◽  
Kit Yu Lu

17 Background: Survivors of breast cancer can face a multitude of long term and late effects after completing active treatment. Recommendations for side effect management can vary widely based on professional society guidelines, a provider’s clinical experience, and patient preference. When providing survivorship care in a multidisciplinary institution, maintaining consistent recommendations between providers and disciplines can be a daunting challenge. A cohesive approach is extremely important for a satisfying patient-clinician relationship and for patient safety. Our objective is to create standardized management of breast cancer survivorship issues. Methods: A quarterly Survivorship Multidisciplinary Conference (SMC) was initiated for case review and education on side effect management. The multidisciplinary group included medical and radiation oncologists, surgeons, nurse practitioners, nurse navigators, dieticians, physical therapists, social workers, spiritual care, and a genetic counselor. We used an evidence-based approach, including ASCO and NCCN guidelines as well as published peer-reviewed recommendations to create a treatment consensus for side effect management. Clinicians attending SMC were surveyed regarding their approach to late and long term effects of breast cancer pre- and post-SMC and their overall satisfaction with the conference. Results: Prior to involvement in SMC, most providers based their treatment of side effects on their own professional society’s guidelines and their personal clinical experience. After implementing SMC, 60% of providers reported a change in their practice and there was a 37.5% reported increase in the use of ASCO and NCCN survivorship guidelines across disciplines. 94% of providers reported the SMC is effective in providing evidence based guidelines. Providers also reported a high level of satisfaction and that SMC provided opportunity for a more collaborative multidisciplinary approach. Conclusions: Survivorship Multidisciplinary Conference brings multiple specialties together for review of evidence-based approaches to survivorship care, increasing consistency in management of survivors' late and long term effects after completing breast cancer treatment.

1999 ◽  
Vol 6 (3) ◽  
pp. 256-263 ◽  
Author(s):  
Paul B. Jacobsen ◽  
Kevin Stein

2011 ◽  
pp. 143-147
Author(s):  
Dongfeng Wu ◽  
Adriana Pérez

Breast cancer screening programs have been effective in detecting tumors prior to symptoms. Recently, there has been concern over the issue of over-diagnosis, that is, diagnosis of a breast cancer that does not manifest prior to death. Estimates for over-diagnosis vary, ranging from 7 to 52%. This variability may be due partially to issues associated with bias and/or incorrect inferences associated with the lack of probability modeling. A critical issue is how to evaluate the long-term effects due to continued screening. Participants in a periodic screening program can be classified into four mutually exclusive groups depending on whether individuals are diagnosed and whether their symptoms appear prior to death: True-earlydetection; No-early-detection; Over-diagnosis; and Not-sonecessary. All initially superficially healthy people will eventually fall into one of these four categories. This manuscript reviews the major methodologies associated with the over-diagnosis and long-term effects of breast cancer screening.


2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Donna M. Williams ◽  
Kathryn Evans Kreider

The prevalence of type 2 diabetes in women of reproductive age ranges from 3% to 7%. Due to the common nature of this condition, it is imperative for nurse practitioners who care for women to understand evidence-based methods of diabetes management. The aim of this article is to describe current screening and diagnostic criteria for type 2 diabetes, discuss current evidence-based management and patient education necessary to prevent long-term complications, and provide the tools for a healthy reproductive plan in women with type 2 diabetes from puberty until menopause. Diabetes management extends well beyond glucose control, and nurse practitioners should be attuned to all factors that can impact cardiovascular risk and quality of life.


Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1669 ◽  
Author(s):  
Ayelet Alfasi ◽  
Irit Ben-Aharon

Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk–benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects.


2019 ◽  
Vol 79 (06) ◽  
pp. 618-625 ◽  
Author(s):  
Sophia S. Goller ◽  
Udo R. Markert ◽  
Karolin Fröhlich

AbstractBreast cancer is one of the most common malignancies which appear during pregnancy. Since women are increasingly not giving birth until they are at a more advanced age, it can be assumed that the incidence of pregnancy-related breast cancers will continue to increase in the future. Because of pregnancy-induced changes and conservative diagnosis, these carcinomas are frequently not detected until they are at an advanced stage and thus generally require systemic adjuvant therapy. The available data on optimal chemotherapeutic management are limited. Particularly for the use of the target agent trastuzumab which could crucially contribute to improving the prognosis in the therapy of HER2-overexpressing breast cancer in non-pregnant women, there is a lack of definitive information regarding the profile of action and safety in pregnancy as well as with regard to any long-term effects on the child. Thirty-eight pregnancies on trastuzumab for the treatment of breast cancer were able to be analysed in the literature currently available. Information can be gained from this and conclusions can be drawn which can individualise and decisively improve therapeutic options in the future for the pregnant breast cancer patient.


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