scholarly journals OUT OF POCKETS SPENDING AMONG BREAST CANCER WOMEN RECEIVING OUT-PATIENT TREATMENT IN A TERTIARY TEACHING HOSPITAL IN KUALA LUMPUR MALAYSIA

2021 ◽  
Vol 21 (3) ◽  
pp. 240-249
Author(s):  
Jamilah Yusoff ◽  
Aniza Ismail
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Patient Treatment ◽  
Cost Calculation ◽  
Cost Component ◽  
Cross Sectional ◽  
Tertiary Teaching

There is lack of information about the estimates of out-of-pocket (OOP) spending among women diagnosed with breast cancer and effects on their family’s financial situation in Malaysia. This study is to determine estimates of out-of-pocket spending among women with breast cancer in HCTM and identify factors that significantly associated with high OOP spending. This cross-sectional study assessed out of pockets spending among breast cancer women in HCTM for breast cancer as out-patient. Sampling unit is a woman who has been diagnosed breast cancer and receiving treatment and follows up in HCTM. A 189 breast cancer women were identified for a 6 months period between July to December 2017. Only those patients who received at least 6 months treatment in HCTM were recruited. Out of pocket spending for treatments for adjuvant therapy and follow up, consultations with other practitioners, care taker fee, equipment and traditional/complementary treatment were collected by face-to-face interview using structured questionnaires. The dependent variable was OOP, analyzed using SSPS v23 for descriptive analysis and both univariate and multivariate analysis.173 out of 186 women were recruited and only 172 were considered for cost calculation (participation rate, 93.0 %) in this study. Total out of pocket spending for breast cancer treatment in 2017 was RM 1,037,446.23 with women’s total means out of pocket spending was RM6031.66 (SD =/- 495.58). The highest percentage of cost component contributed by cost of adjuvant therapy, RM334,056.00 (30.2%) followed by traditional/complementary medicine, RM268,278.00 (24.3%), other expenses/private hospital, RM224,887.00 (20.4%), transportation RM 79,772.52 (7.2%), chemotherapy RM67,300.00 (6.1%), dressing RM54,850.00 (5.0%), equipment/prosthesis RM50,550.00 (4.6%) and care taker cost RM24,661.43 (2.2%). Out of pockets costs from breast cancer in HCTM for 2017 are a burden for women and their family. Financial support provides assistance to the out-of-pocket spending in breast cancer treatment and is able to reduce the financial burden among patients and families.  

scholarly journals Identification and Management of Lymphedema in Patients With Breast Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. 255-262 ◽  
Author(s):  
Pavankumar Tandra ◽  
Avyakta Kallam ◽  
Jairam Krishnamurthy
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Treatment ◽  
Early Stage ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Initial Diagnosis ◽  
Axillary Surgery ◽  
Incidence Risk ◽  
End Stage

Breast cancer–related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Other risk factors include obesity and infections. Given the 5-year survival rate of 90% and its potential impact on the quality of life of survivors of breast cancer, BCRL has become a significant financial burden on the health care system. Minimizing axillary surgery and radiation has been proven to reduce the risk of BCRL. Comprehensive multidisciplinary assessment at the time of initial diagnosis; early referral to physical therapy after surgery; and patient education regarding weight loss, skin, and nail care are cornerstones of the management of early-stage lymphedema. End-stage lymphedema may benefit from referral to a plastic surgeon specializing in lymphedema surgery. In this review, we attempt to review the incidence, risk factors, staging, prevention, and management of this complication of breast cancer treatment. We also describe our multidisciplinary approach for the prevention of this complication at the time of initial diagnosis.

scholarly journals Guidelines for the prevention of secondary lymphedema following breast cancer treatment: adhesion and associated factors

Mastology ◽  
2021 ◽  
Vol 31 ◽  
Author(s):  
Erica Alves Nogueira Fabro ◽  
Flávia Oliveira Macedo ◽  
Rejane Medeiros Costa ◽  
Marianna Brito de Araújo Lou ◽  
Liz de Oliveira Marchito ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Patient Adherence ◽  
Breast Cancer Treatment ◽  
Cross Sectional ◽  
Central Tendency Measure ◽  
Axillary Lymphadenectomy ◽  
Education Levels ◽  
Lower Education ◽  
White Patients

Introduction: Lymphedema is the most feared complication that may take place after breast cancer treatment. With treatment progression, doubts have arisen regarding the real benefits of lymphedema prevention care, as well as of patient adherence to guidelines. Objective: In this context, the aim of this study was to assess patient adherence to preventive lymphedema guidelines and the distribution of sociodemographic, clinical, and treatment variables according to adherence to treatment. Methods: A cross-sectional study conducted at the Cancer Hospital III/INCA, Rio de Janeiro, Brazil, concerning patients with breast cancer undergoing surgical treatment with an axillary approach. Participants were questioned about assistance care performance, exercise-related care, and limb ipsilateral to surgery care. A descriptive analysis of patient demographic, clinical, treatments, postoperative complications variables, and main outcomes (adherence to the guidelines) was performed through a central tendency measure and data dispersion and frequency measures analyses. Differences between means were assessed using the Student’s t-test, while differences between proportions were evaluated using the chi-square test. A significance level of 5% was considered for all assessments. Results: Of the 103 women included in this study, 89.3% adhered to assistance care, 61.2% adhered to limb care, and 42.7% performed exercise-related care. Women undergoing chemotherapy (p = 0.030) and axillary lymphadenectomy (AL) (p = 0.017) exhibited greater adherence to care. Non-white patients (p = 0.048) and those who underwent AL (p = 0.025) adhered to limb care more frequently. Finally, patients displaying lower education levels (p = 0.013) and those who underwent AL (p = 0.009) adhered more frequently to limb exercises. Conclusion: Patients adhered the most to assistance care and limb care compared to exercise practice. Patients undergoing chemotherapy displayed greater adherence to care and non-white patients adhered the most to limb care. Women who underwent AL displayed greater adherence to all types of care and those presenting lower education levels adhered more frequently to exercise guidelines.

scholarly journals Development of Machine Learning Algorithms for the Prediction of Financial Toxicity in Localized Breast Cancer Following Surgical Treatment

2021 ◽  
pp. 338-347
Author(s):  
Chris Sidey-Gibbons ◽  
André Pfob ◽  
Malke Asaad ◽  
Stefanos Boukovalas ◽  
Yu-Li Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Cancer Treatment ◽  
Linear Model ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Support Vector ◽  
Financial Toxicity ◽  
Operating Characteristics ◽  
Patient Reported

PURPOSE Financial burden caused by cancer treatment is associated with material loss, distress, and poorer outcomes. Financial resources exist to support patients but identification of need is difficult. We sought to develop and test a tool to accurately predict an individual's risk of financial toxicity based on clinical, demographic, and patient-reported data prior to initiation of breast cancer treatment. PATIENTS AND METHODS We surveyed 611 patients undergoing breast cancer therapy at MD Anderson Cancer Center. We collected data using the validated COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure alongside other financial indicators (credit score, income, and insurance status). We also collected clinical and perioperative data. We trained and tested an ensemble of machine learning (ML) algorithms (neural network, regularized linear model, support vector machines, and a classification tree) to predict financial toxicity. Data were randomly partitioned into training and test samples (2:1 ratio). Predictive performance was assessed using area-under-the-receiver-operating-characteristics-curve (AUROC), accuracy, sensitivity, and specificity. RESULTS In our test sample (N = 203), 48 of 203 women (23.6%) reported significant financial burden. The algorithm ensemble performed well to predict financial burden with an AUROC of 0.85, accuracy of 0.82, sensitivity of 0.85, and specificity of 0.81. Key clinical predictors of financial burden from the linear model were neoadjuvant therapy (βregularized, .11) and autologous, rather than implant-based, reconstruction (βregularized, .06). Notably, radiation and clinical tumor stage had no effect on financial burden. CONCLUSION ML models accurately predicted financial toxicity related to breast cancer treatment. These predictions may inform decision making and care planning to avoid financial distress during cancer treatment or enable targeted financial support. Further research is warranted to validate this tool and assess applicability for other types of cancer.

ORAL SIDE EFFECTS OF SYSTEMIC TREATMENT IN WOMEN WITH BREAST CANCER VISITING REHMAN MEDICAL INSTITUTE PESHAWAR : A CROSS-SECTIONAL SURVEY

JKCD ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 12-14
Author(s):  
Amjid Ali
Keyword(s):  
Breast Cancer ◽  
Health Status ◽  
Oral Health ◽  
Cancer Treatment ◽  
Oral Health Status ◽  
Breast Cancer Treatment ◽  
Medical Institute ◽  
Control Group ◽  
Cross Sectional ◽  
Immunological Therapy

Objectives: The aim of the study was to characterize the oral health in breast cancer survivors treated in the Rehman Medical Institute, Peshawar. Materials & Methods: This was a cross-sectional study conducted at the Rehman Medical Institute Peshawar between Jan 2017 and June 2018 of women diagnosed with Breast Cancer who received care. Forty three patients were selected in both breast cancer groups as well as in control group. Initially diagnosed patients of breast cancer, followed by surgical therapy and additional radio and chemotherapy were included in this study. Whereas female patients who received (supplementary/solely) endocrine or immunological therapy were excluded from this study, similarly were the women with severe chronic diseases such as chronic heart disease, chronic obstructive pulmonary disease and other cancers. Statistical analysis analysis were performed with the SPSS , Version 22.0. Results: Unfavorable oral health status of women who received breast cancer treatment compared to the oral health status of the control group has been shown in this study. Conclusion: Results indicate a need for more education about the potential oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.

Are high mastectomy rates associated with unwanted variation in other aspects of breast cancer treatment? An overview of practice patterns in Alberta, Canada in 2009-2010.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 102-102
Author(s):  
Sarah Morrissey ◽  
May Lynn Quan
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Cancer Treatment ◽  
Practice Patterns ◽  
Guideline Implementation ◽  
Breast Cancer Treatment ◽  
Study Cohort ◽  
Treatment Practices ◽  
Knowledge Translation Strategies ◽  
Performance Report

102 Background: The Canadian Partnership Against Cancer recently released a system performance report identifying large variation in breast cancer treatment across Canada. Contrary to provincial guidelines, Alberta had higher than average rates of mastectomy (56%); however, factors driving this variation remain unknown. We sought to (1) determine if practice patterns of primary breast surgery and adjuvant therapy adhered to guidelines and (2) to describe influencing factors on treatment practices between the two major cancer programs in Alberta to inform future knowledge translation strategies for guideline implementation. Methods: All patients diagnosed with breast cancer (ICD 9-174) between January 2009 and December 2010 were identified from the Alberta Cancer Registry. Demographic, surgical, treatment, and pathology data were abstracted from the electronic health record. Descriptive statistics and t-testing comparing mastectomy rates, axillary surgery and adjuvant therapy between the two major cancer programs were performed. Results: There were 2,817 surgeries for early breast cancer in the study cohort between 2009 and 2010. Conclusions: Practice patterns identify variance from current guidelines. Mastectomy rates are influenced by surgeon volume and tumor size. Management of positive SN and adjuvant therapy is variable and may reflect under treatment. Further investigation of drivers for mastectomy and adjuvant therapy are necessary. [Table: see text]

Machine learning algorithms to predict financial toxicity associated with breast cancer treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2047-2047 ◽  
Author(s):  
Chris Sidey-Gibbons ◽  
Malke Asaad ◽  
André Pfob ◽  
Stefanos Boukovalas ◽  
Yu-Li Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Decision Making ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Support Vector ◽  
Financial Toxicity ◽  
Operating Characteristics ◽  
Patient Reported

2047 Background: Financial burden caused by cancer treatment is associated with material loss, distress, and poorer outcomes. Financial resources exist to support patients but objective identification of individuals in need is difficult. Accurate predictions of an individual’s risk of financial toxicity prior to initiation of breast cancer treatment may facilitate informed clinical decision making, reduce financial burden, and improve patient outcomes. Methods: We retrospectively surveyed 611 patients who had undergone breast cancer therapy at MD Anderson Cancer Center to assess the financial impact of their care. All patients were over 18 and received either a lumpectomy or a mastectomy. We collected data using the FACT-COST patient-reported outcome measures alongside other financial indicators including income and insurance status. We extracted clinical and perioperative data from the electronic health record. Missing data were imputed using multiple imputation. We used this data to train and validate a neural network, LASSO-regularized linear model, and support vector machines. Data were randomly partitioned into training and validation samples (3:1 ratio). Analyses were informed by international PROBAST recommendations for developing multivariate predictors. We combined algorithms into a voting ensemble and assessed predictive performance using area under the receiver operating characteristics curve (AUROC), accuracy, sensitivity, and specificity. Results: In our validation sample, 48 of 203 (23.6%) women reported FACT-COST scores commensurate with significant financial burden. The algorithm predicted significant financial burden relating to cancer treatment with high accuracy (Accuracy = .83, AUROC = .82, sensitivity = .81, specificity = .82). Key clinical predictors of financial burden from linear models were neo-adjuvant therapy (βregularized 0.12) and autologous, rather than implant-based, reconstruction (βregularized 0.10). Conclusions: Machine learning models were able to accurately predict the occurrence of financial toxicity related to breast cancer treatment. These predictions may be used to inform decision making and care planning to avoid financial distress during cancer treatment or to enable targeted financial support for individuals. Further research is warranted to further improve this tool and assess applicability for other types of cancer.

scholarly journals Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1804
Author(s):  
Virginia Prieto-Gómez ◽  
Beatriz Navarro-Brazález ◽  
Óscar Sánchez-Méndez ◽  
Pedro de-la-Villa ◽  
Beatriz Sánchez-Sánchez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Muscle Activity ◽  
Descriptive Study ◽  
Breast Cancer Treatment ◽  
Persistent Pain ◽  
Cross Sectional ◽  
Neuromuscular Activity ◽  
Healthy Women ◽  
Peripheral Pain

Certain secondary effects derived from medical treatment in breast cancer can favor the development of alterations in shoulder biomechanics. To the best of our knowledge, persistent peripheral pain as a key factor for the development of neuromuscular activity impairments has not been analyzed. A cross-sectional descriptive study was carried out. A total of 90 women were included and allocated to three groups: (i) 30 women with persistent peripheral pain after breast cancer treatment, (ii) 30 women without pain after breast cancer treatment, and (iii) 30 healthy women. Surface electromyography was employed to measure the onset and amplitude of the muscle activity of three shoulder movements. Statistically significant differences were found in the neuromuscular activity for all the muscles and shoulder movements among women with persistent pain versus healthy women (i.e., amplitude muscle activity variable p < 0.001). Statistically significant differences were also observed in the neuromuscular activity for certain muscles in shoulder movements among women with persistent pain versus women without pain, as well as between women without pain versus healthy women. Therefore, following breast cancer treatment, women showed alterations in their shoulder neuromuscular activity, which were more significant if persistent pain existed. These findings may contribute to developing a selective therapeutic exercise program that optimizes the shoulder neuromuscular activity in women after breast cancer treatment.

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