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.

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.

Community-Based Use of Chemotherapy and Hormonal Therapy for Early-Stage Breast Cancer: 1987-2000

2006 ◽  
Vol 24 (6) ◽  
pp. 872-877 ◽  
Author(s):  
Linda C. Harlan ◽  
Limin X. Clegg ◽  
Jeffrey Abrams ◽  
Jennifer L. Stevens ◽  
Rachel Ballard-Barbash
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Hormonal Therapy ◽  
Early Stage ◽  
The United States ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Community Based ◽  
Node Negative ◽  
Er Positive

Purpose We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer. Methods Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study. Results The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer ≥ 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors ≥ 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors ≥ 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older. Conclusion The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.

scholarly journals Round Block Technique Versus Reduction Mammoplasty in Treatment of Early Breast Cancer

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S A Abdelrahman ◽  
A A Reda ◽  
S M Guirguis ◽  
K F Abdelmoaty ◽  
S E Abdelhakim
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Early Stage ◽  
Reduction Mammoplasty ◽  
Cosmetic Outcome ◽  
Surgical Margins ◽  
Medium Size ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Abstract Background Early breast cancer can be defined as the presence of a mobile tumor within the breast with or without associated mobile enlarged lymph nodes, and represents the vast majority of patients who present now with breast cancer. Breast-conserving treatment (BCT) has become the standard treatment in early-stage breast cancer; Its goal is to provide a treatment as effective as mastectomy, with the added benefit of a preserved breast. Aims The aim of the study is the comparison between Round block technique and Reduction mammoplasty in management of early breast cancer. Methodology This is a prospective controlled clinical study which included 30 patients, who were admitted to Ain Shams University Hospitals, with a diagnosis of early breast cancer T1 or T2, N0 or N1, M0. Patients were subdivided into 2 groups: Group I: This group is composed of 15 patients with early breast cancer (T1 or T2, N0 or N1, MO) underwent\Round block rechnique. Group II: This group is composed of 15 patients with early breast cancer (T1 or T2, N0 or N1, MO) underwent Reduction mammoplasty. Results In our study, there was no significant statistical difference between the two groups regarding: patients age, our patients were younger in comparable to other studies as we reported average age 47(30-62 years) and 43 (30-64 years). Family history, as 2(40%) and 1(30%) in first degree family members. Side of the lesion (mass), was in right breast in (53.3%) and (60%) in group (I) (Round block group) and group(II) (Reduction mammoplasty group), respectively. There was a significant difference, between the two groups as regard: Intraoperative blood loss, intraoperative time, hospital stay, postoperative complication and cosmetic outcome Conclusion Oncoplastic surgery gives a new tool for the treatment of breast cancer as much larger volume of breast tissue can be excised, and wider surgical margins can be achieved especially for larger tumors with better cosmetic outcome, in which a standard resection can lead to poor cosmetic results and tumor-involved surgical margins. Patients with early breast cancer with medium size breast with no major ptosis that are candidate for Round block technique and reduction mammoplasty, round block technique is better for them as there is less morbidity, less complications so no delay in radiotherapy, better cosmesis, mostly doesn’t need contralateral breast surgery for symmetrization and Reduction mammoplasty needs more surgeon’s experience.

Correlation of high body mass index and circulating tumor cell positivity in patients with early-stage breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1600-1600 ◽  
Author(s):  
Uta Ortmann ◽  
Wolfgang Janni ◽  
Ulrich Andergassen ◽  
Thomas Beck ◽  
Matthias W. Beckmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Early Breast Cancer ◽  
Early Stage ◽  
High Body Mass Index ◽  
Obese Patients ◽  
Cellsearch System ◽  
Significant Difference

1600^ Background: The prognostic relevance of both body mass index (BMI) and circulating tumor cells (CTC) has been confirmed in different trials for patients with early breast cancer. This analysis evaluates the correlation between high BMI and CTC positivity as risk factors for reduced disease free and overall survival. Methods: Data of 3658 patients of the SUCCESS A trial have been analyzed. CTC count and BMI were documented before (N = 2026) and after (N = 1504) chemotherapy. Within this trial patients with early breast cancer were randomized to two chemotherapy regimens and received either 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel (FE100C-Doc) or 3 cycles of fluorouracil, epirubicin and cyclophosphamide followed by 3 cycles of docetaxel and gemcitabine(FE100C-DG). In addition, patients were randomized to zoledronic acid either for 2 or 5 years. CTC were analyzed using the CellSearch System (Veridex, USA). Different groups of bodyweight were classified according to the WHO’s international definition: Underweight (BMI < 18,5 kg/m2), normal range (BMI > 18,5- < 25), overweight (BMI >25- < 30), obesity (BMI > 30). Correlation between CTC count and BMI was analyzed using frequency-table methods. Results: At study entry 24 (1.2%) patients were underweight, 952 (47%) patients were normal weight, 658 (32.5%) patients were overweight and 392 (19.4%) patients were obese. Before the start of chemotherapy, CTC were detected in 435 (21.5%) patients. We did not find a correlation between CTC positivity and BMI (p=0.94). After chemotherapy CTC were detected in 330 (16,3%) patients. Again, there was no statistically significant correlation between BMI and CTC positivity (p=0.86). In particular, CTC positivity was not observed more frequently in obese patients neither before (p=0.70) nor after chemotherapy (p=0.95) compared to patients with a BMI < 30 kg/m2. Conclusions: As compared to patients with normal BMI, there was no significant difference in the prevalence of CTC in underweight, overweight and obese patients, respectively, neither before nor after chemotherapy. The risk factors obesity and prevalence of CTC seem to be independent prognostic factors.

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.

Variations in objective knowledge among decision-support persons of patients with early stage breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19110-e19110
Author(s):  
Victoria A Wytiaz ◽  
Christine M Veenstra ◽  
Sarah T. Hawley
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Cancer Treatment ◽  
Early Stage ◽  
Treatment Options ◽  
Breast Cancer Treatment ◽  
Objective Knowledge ◽  
Level Of Education ◽  
High Knowledge

e19110 Background: Patients with breast cancer face complex decisions regarding treatment options, and frequently involve family, friends, and other decision supporters in decision-making. A high-quality decision is one that is both informed and values-concordant. While much has been done to evaluate the quality of decision-making among patients, very little is known about how decision supporters fit within that framework. Thus, we sought to understand variations in objective knowledge among decision supporters. Methods: Patients with stage 0-II breast cancer reported to Georgia and LA SEER registries in 2014-15 and their key decision support person (DSP) were surveyed separately. DSPs were asked 4 objective knowledge questions regarding breast cancer treatment with responses dichotomized into high/low knowledge. Bivariate analyses and multivariable regression models were used to assess associations between DSP knowledge and important DSP characteristics (type of DSP, age, race, education), level of DSP engagement in 3 domains of patients’ decision-making (feeling informed about decisions, extent of and satisfaction with their involvement in decisions, and being aware of patients’ values/preferences), and patient clinical factors (stage, chemotherapy receipt, radiation receipt, type of surgery). Results: 2502 patients (68% RR) and 1203 eligible DSPs (70% RR) responded. Most DSPs were husbands or daughters. 21% were Latino, 17% were black, 20% had <high school education. Overall,53% DSPs had high objective knowledge. DSPs with high knowledge were more likely to be non-Black, non-Spanish-speaking Latinos, have a higher level of education, and report high engagement in the domains of satisfaction with their involvement in patients’ decision-making and awareness of patients’ values/preferences (all p < 0.05). After adjustment, high objective knowledge among DSPs was associated a higher level of education (OR = 2.44; 95% CI = 1.67-3.57) and high awareness of patients’ values/preferences (OR = 1.40; 95% CI = 1.06-1.84). Conclusions: Objective knowledge about breast cancer treatment was varied among DSPs of patients with breast cancer. Highly engaged DSPs (aware and satisfied) were more likely to have high knowledge, suggesting that involving DSPs may be an untapped mechanism for improving patients’ understanding of treatment options. These finding suggest that DSPs can play a role in improving decision quality in patients, and that interventions focused on decision-making may benefit from modules directed to DSPs as well as patients.

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.

Improving Response to Hormone Therapy in Breast Cancer: New Targets, New Therapeutic Options

2016 ◽  
pp. e40-e54 ◽  
Author(s):  
Hope S. Rugo ◽  
Neelima Vidula ◽  
Cynthia Ma
Keyword(s):  
Breast Cancer ◽  
Growth Factor ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Growth Factor Receptor ◽  
The United States ◽  
Topical Steroids ◽  
Early Stage Disease ◽  
Her Family

The majority of breast cancer expresses the estrogen and or progesterone receptors (ER and PR). In tumors without concomitant HER2 amplification, hormone therapy is a major treatment option for all disease stages. Resistance to hormonal therapy is associated with disease recurrence and progression. Recent studies have identified a number of resistance mechanisms leading to estrogen-independent growth of hormone receptor–positive (HR+) breast cancer as a result of genetic and epigenetic alterations, which could be exploited as novel therapeutic targets. These include acquired mutations in ER-alpha ( ESR1) in response to endocrine deprivation; constitutive activation of cyclin-dependent kinases (CDK) 4 and 6; cross talk between ER and growth factor receptor signaling such as HER family members, fibroblast growth factor receptor (FGFR) pathways, intracellular growth, and survival signals PI3K/Akt/mTOR; and epigenetic modifications by histone deacetylase (HDAC) as well as interactions with tumor microenvironment and host immune response. Inhibitors of these pathways are being developed to improve efficacy of hormonal therapy for treatment of both metastatic and early-stage disease. Two agents are currently approved in the United States for the treatment of metastatic HR+ breast cancer, including the mTOR inhibitor everolimus and the CDK4/6 inhibitor palbociclib. Management of toxicity is a critical aspect of treatment; the primary toxicity of everolimus is stomatitis (treated with topical steroids) and of palbociclib is neutropenia (treated with dose reduction/delay). Many agents are in clinical trials, primarily in combination with hormone therapy; novel combinations are under active investigation.

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.

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