scholarly journals Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals

2018 ◽  
Vol 14 (3) ◽  
pp. e158-e167
Author(s):  
Nina A. Bickell ◽  
Ajay Shah ◽  
Maria Castaldi ◽  
Theophilus Lewis ◽  
Alan Sickles ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Implementation Research ◽  
Care Delivery ◽  
Safety Net ◽  
Breast Cancer Treatment ◽  
Breast Cancer Surgery ◽  
Key Informants ◽  
High Volume Hospital

Purpose: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). Patient and Methods: We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool’s usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. Results: Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. Conclusion: A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research.

Hazard of Recurrence among Women after Primary Breast Cancer Treatment—A 10-Year Follow-up Using Data from SEER-Medicare

2012 ◽  
Vol 21 (5) ◽  
pp. 800-809 ◽  
Author(s):  
Lee Cheng ◽  
Michael D. Swartz ◽  
Hui Zhao ◽  
Asha S. Kapadia ◽  
Dejian Lai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Primary Breast Cancer ◽  
Breast Cancer Treatment ◽  
Using Data

Lymphedema of breast cancer: risk factor and treatment

2015 ◽  
Vol 3 (4) ◽  
pp. 306-321
Author(s):  
Ana H. Losken ◽  
Elisa Mullan
Keyword(s):  
Breast Cancer ◽  
Risk Factor ◽  
Cancer Treatment ◽  
Breast Cancer Risk Factor ◽  
Breast Cancer Treatment ◽  
Breast Cancer Surgery ◽  
Secondary Lymphedema ◽  
Lymph Node Transfer ◽  
Arm Lymphoedema ◽  
Chronic Lymphedema

One of the well-known complication of breast cancer treatment is secondary lymphedema; an accumulation of protein-rich interstitial fluid due to the insufficient capacity of the lymphatic system. Lymphedema are affects about 20-30% of women following breast cancer treatment and the risk factors associated with lymphedema development after breast cancer surgery and or radiotherapy are not well established. Early diagnosis and treatment is considered important for successful management of breast cancer related arm lymphoedema. The objective of this study is to assess the value of risk factor and treatment modality of lymphedema. Electronic searches were conducted in MEDLINE®, EMBASE, CINAHL®, and Social Sciences Citation Index. Articles were included where researchers used qualitative research methods and when a comprehensive description of methods and the study's findings were provided. Among 1210 articles, 30-37% developed lymphedema and 45% associated with incresead body mass index (BMI), 53% related with higher stage of disease. Furthermore; 74% strongly step rise with the number of involved lymph nodes; 41% in comorbid diseases, and the time after surgery showed significant correlation with the development of lymphedema in 32%. Suction-assisted protein lipectomy (SAPL) has been shown to safely and effectively reduce the solid component of swelling in chronic lymphedema and microsurgery procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), have been shown to be effective in the management of the fluid component of lymphedema and allow for decreased garment use.

Do breast cancer treatment and imaging providers follow hereditary breast and ovarian cancer risk screening guidelines?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 207-207
Author(s):  
Katherine Y. Tossas-Milligan ◽  
Anne Marie Murphy ◽  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Melissa A. Simon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Cancer Treatment ◽  
Breast Imaging ◽  
Safety Net ◽  
Breast Cancer Treatment ◽  
Screening Process ◽  
Risk Screening ◽  
Screening Guidelines ◽  
Genetic Assessment

207 Background: Women with personal or family history suggestive of susceptibility to hereditary breast or ovarian cancer (HBOC) should be referred to genetic assessment (USPSTF, Ann Intern Med. 2005). Women with HBOC have a 50-85% lifetime risk of breast cancer, 30-50% of breast cancer before 50 years old,15-50% lifetime risk of ovarian cancer, and 40-60% chance of developing a second breast cancer (ASCO Cancer.net HBOC 8/2013). Our goal is to examine if this almost decade old guideline is followed in breast cancer treatment and breast cancer imaging centers in a large metropolitan area. Methods: We conducted an IRB approved web survey of all 35 breast cancer treatment sites (5 academic, 21 community, 9 public or safety net) and 58 breast imaging sites (5 academic, 27 community, 26 public or safety net) in Chicago. Results were analyzed using simple frequencies and Fisher's exact test. Results: We achieved a response rate of 91% (32/35 treatment sites, 53/58 imaging sites). We found that 56% (18/32) of treatment sites have a hereditary cancer syndrome (HBOC) screening process for newly diagnosed breast cancer patients. Most of these sites, 83% (15/18), always use genetic test results in surgical decisions, as compared to 21% (3/14) of sites that do not have an HBOC screening process, p=0.0009. Only 8% (4/53) of breast imaging sites have an HBOC screening process and provide indicated patients genetic assessment information and/or referrals. While 38% (20/53) of imaging sites conduct daily internal staff discussions of hereditary risk, only 15% of them (3/20) provide genetic assessment information to indicated patients. We found no statistically significant difference between practices of academic, community, public and safety net sites. Conclusions: Breast cancer treatment sites have partial adherence to HBOC risk screening guidelines; while breast imaging sites rarely adhere to HBOC risk assessment guidelines. Consistent HBOC risk screening protocols are needed in breast cancer treatment and breast cancer imaging sites that include providing indicated patients information about, and access to, genetic assessment.

Distress screening remains important during follow-up after primary breast cancer treatment

2013 ◽  
Vol 21 (8) ◽  
pp. 2107-2115 ◽  
Author(s):  
Floortje K. Ploos van Amstel ◽  
Sanne W. van den Berg ◽  
Hanneke W. M. van Laarhoven ◽  
Marieke F. M. Gielissen ◽  
Judith B. Prins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Primary Breast Cancer ◽  
Breast Cancer Treatment ◽  
Distress Screening

scholarly journals Prevalence of breast cancer treatment sequelae over 6 years of follow-up

Cancer ◽  
2012 ◽  
Vol 118 (S8) ◽  
pp. 2217-2225 ◽  
Author(s):  
Kathryn H. Schmitz ◽  
Rebecca M. Speck ◽  
Sheree A. Rye ◽  
Tracey DiSipio ◽  
Sandra C. Hayes
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Breast Cancer Treatment
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