550 Records downloaded - Mon Jun 26 16:08:08 UTC 2017 RECORD 1 TITLE Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions AUTHOR NAMES Wang S.-Y. Kelly G. Gross C. Killelea B.K. Mougalian S. Presley C. Fraenkel L. Evans S.B. AUTHOR ADDRESSES (Wang S.-Y., shiyi.wang@yale.edu; Kelly G.) Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, United States. (Wang S.-Y., shiyi.wang@yale.edu; Gross C.; Killelea B.K.; Mougalian S.; Presley C.; Evans S.B.) Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, United States. (Gross C.) Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States. (Killelea B.K.) Department of Surgery, Yale University School of Medicine, New Haven, United States. (Mougalian S.; Presley C.) Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States. (Fraenkel L.) Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, United States. (Evans S.B.) Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States. CORRESPONDENCE ADDRESS S.-Y. Wang, Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, PO Box 208034, New Haven, United States. Email: shiyi.wang@yale.edu SOURCE International Journal of Radiation Oncology Biology Physics (2017) 98:4 (733-740). Date of Publication: 15 Jul 2017 ISSN 1879-355X (electronic) 0360-3016 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Purpose To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. Methods and Materials We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker. Results The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as “essential.” Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018). Conclusions Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants. EMTREE DRUG INDEX TERMS estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer radiotherapy medical information patient decision making EMTREE MEDICAL INDEX TERMS aged article cancer recurrence chronic lung disease diabetes mellitus educational status female health survey heart disease human insurance lumpectomy major clinical study malignant neoplasm medicare physical capacity priority journal telephone interview EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170242868 PUI L615118870 DOI 10.1016/j.ijrobp.2017.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2017.02.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 2 TITLE Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculator for Initial Prostate Biopsy by Incorporating the 2014 International Society of Urological Pathology Gleason Grading and Cribriform growth AUTHOR NAMES Roobol M.J. Verbeek J.F.M. van der Kwast T. Kümmerlin I.P. Kweldam C.F. van Leenders G.J.L.H. AUTHOR ADDRESSES (Roobol M.J., m.roobol@erasmusmc.nl; Verbeek J.F.M.) Department of Urology, Erasmus Medical Center, Rotterdam, Netherlands. (van der Kwast T.; Kümmerlin I.P.; Kweldam C.F.; van Leenders G.J.L.H.) Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS M.J. Roobol, Department of Urology, Erasmus University Medical Center, P.O. Box 2040, Rotterdam, Netherlands. Email: m.roobol@erasmusmc.nl SOURCE European Urology (2017) 72:1 (45-51). Date of Publication: 1 Jul 2017 ISSN 1873-7560 (electronic) 0302-2838 BOOK PUBLISHER Elsevier B.V. ABSTRACT Background The survival rate for men with International Society of Urological Pathology (ISUP) grade 2 prostate cancer (PCa) without invasive cribriform (CR) and intraductal carcinoma (IDC) is similar to that for ISUP grade 1. If updated into the European Randomized Study of Screening for Prostate Cancer (ERSPC Rotterdam) risk calculator number 3 (RC3), this may further improve upfront selection of men who need a biopsy. Objective To improve the number of possible biopsies avoided, while limiting undiagnosed clinically important PCa by applying the updated RC3 for risk-based patient selection. Design, setting, and participants The RC3 is based on the first screening round of the ERSPC Rotterdam, which involved 3616 men. In 2015, histopathologic slides for PCa cases (n = 885) were re-evaluated. Low-risk (LR) PCa was defined as ISUP grade 1 or 2 without CR/IDC. High-risk (HR) PCa was defined as ISUP grade 2 with CR/IDC and PCa with ISUP grade≥3. Outcome measurements and statistical analysis We updated the RC3 using multinomial logistic regression analysis, including data on age, PSA, digital rectal examination, and prostate volume, for predicting LR and HR PCa. Predictive accuracy was quantified using receiver operating characteristic analysis and decision curve analysis. Results and limitations Men without PCa could effectively be distinguished from men with LR PCa and HR PCa (area under the curve 0.70, 95% confidence interval [CI] 0.68–0.72 and 0.92, 95% CI 0.90–0.94). At a 1% risk threshold, the updated calculator would lead to a 34% reduction in unnecessary biopsies, while only 2% of HR PCa cases would be undiagnosed. Conclusions A relatively simple risk stratification tool augmented with a highly sensitive contemporary pathologic biopsy classification would result in a considerable decrease in unnecessary prostate biopsies and overdiagnosis of potentially indolent disease. Patient summary We improved a well-known prostate risk calculator with a new pathology classification system that better reflects disease burden. This new risk calculator allows individualized prediction of the chance of having (potentially aggressive) biopsy-detectable prostate cancer and can guide shared decision-making when considering prostate biopsy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer risk cancer screening cribriform growth Gleason score prostate biopsy prostate cancer (diagnosis) tumor growth EMTREE MEDICAL INDEX TERMS adult aged article cancer diagnosis clinical effectiveness clinical evaluation controlled study digital rectal examination high risk patient histopathology human human tissue intraductal carcinoma low risk patient major clinical study male outcome assessment patient risk patient selection priority journal prostate volume receiver operating characteristic risk assessment risk factor EMBASE CLASSIFICATIONS Cancer (16) Urology and Nephrology (28) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170091713 PUI L614293320 DOI 10.1016/j.eururo.2017.01.033 FULL TEXT LINK http://dx.doi.org/10.1016/j.eururo.2017.01.033 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 3 TITLE Family-building After Breast Cancer: Considering the Effect on Adherence to Adjuvant Endocrine Therapy AUTHOR NAMES Benedict C. Thom B. Teplinsky E. Carleton J. Kelvin J.F. AUTHOR ADDRESSES (Benedict C., cbenedict@northwell.edu) Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, United States. (Thom B.; Kelvin J.F.) Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, United States. (Teplinsky E.; Carleton J.) Hofstra Northwell School of Medicine, Monter Cancer Center, New Hyde Park, United States. CORRESPONDENCE ADDRESS C. Benedict, Hofstra Northwell School of Medicine, 600 Community Drive, Manhasset, United States. Email: cbenedict@northwell.edu SOURCE Clinical Breast Cancer (2017) 17:3 (165-170). Date of Publication: 1 Jun 2017 ISSN 1938-0666 (electronic) 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Adherence to endocrine therapy (ET) is a longstanding problem in breast cancer (BC) survivorship care, particularly among younger women. Younger patients have reported lower ET initiation rates and greater rates of early discontinuation and are considered an “at risk” group for nonadherence. For women who hope to have children in the future, concerns about premature menopause and the implications of postponing childbearing for the 5 to 10 years of ET are widespread. Preliminary evidence suggests that prioritizing fertility, along with concerns about side effects, leads to ET noninitiation and early discontinuation. Clinical efforts to improve adherence might need to consider patients’ family-building goals during the course of treatment and to appropriately counsel patients according to their priorities and family-building intentions. Educational materials about family building after cancer are still not consistently available or provided. Helping patients to access trusted informational resources and decision support tools, in conjunction with medical counseling, will promote informed decisions regarding ET adherence and pregnancy that are medically appropriate. Such shared patient–provider decision-making about ET adherence and pregnancy could help to maximize patient autonomy by incorporating their values, preferences, and priorities into decisions, using providers’ medical expertise. EMTREE DRUG INDEX TERMS anastrozole (drug therapy) aromatase inhibitor (drug therapy) exemestane (drug therapy) letrozole (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy) cancer adjuvant therapy cancer hormone therapy family planning medication compliance EMTREE MEDICAL INDEX TERMS access to information decision support system doctor patient relation female fertility human note patient autonomy patient compliance patient counseling patient decision making patient education pregnancy CAS REGISTRY NUMBERS anastrozole (120511-73-1) exemestane (107868-30-4) letrozole (112809-51-5) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170044313 PUI L614076528 DOI 10.1016/j.clbc.2016.12.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.clbc.2016.12.002 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 4 TITLE What are the experiences and motivating factors of women who choose contralateral prophylactic mastectomy at initial breast cancer diagnosis in the absence of a strong family history? AUTHOR NAMES Buck R. AUTHOR ADDRESSES (Buck R.) Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom. CORRESPONDENCE ADDRESS R. Buck, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S26). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: To explore the experience, motivational factors and decision making strategies of women who choose contralateral prophylactic mastectomy (CPM) in the absence of a strong family history of breast cancer at the initial breast cancer diagnosis. Method: The study used a qualitative phenomenological approach to elicit these experiences, from five women diagnosed with breast cancer who choose to have CPM at their initial breast cancer diagnosis. Data was collected using audio-recorded, semi structures interviews and analysed using Colaizzi's (1978) framework for data analysis. Findings: Three overarching themes emerged: Theme 1: Factors contributing to constructing the decision Theme 2: The process of the decision Theme 3: No regret Conclusion: There needs to be a balance between speed of treatment and making sure women have sufficient time to think about their decision. Service provision for these women needs to be considered as well as the quality and the way information is delivered and the nature of communication with health care professionals. A decision making support tool generated from this study could be used to facilitate with the decision making process to assist specialist nurses when counselling, this tool could be trialled in clinical practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer diagnosis family study prophylactic mastectomy EMTREE MEDICAL INDEX TERMS clinical article clinical practice counseling data analysis decision making diagnosis doctor patient relation female human interview nurse velocity LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281173 DOI 10.1016/j.ejso.2017.01.107 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.107 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 5 TITLE Cancer screening in older adults AUTHOR NAMES Salzman B. Sifri R. Amy C. Talerico C. Silverio A. Zale M. AUTHOR ADDRESSES (Salzman B.; Sifri R.; Amy C.; Talerico C.; Silverio A.; Zale M.) Family and Community Medicine, Thomas Jefferson University, Philadelphia, United States. CORRESPONDENCE ADDRESS B. Salzman, Family and Community Medicine, Thomas Jefferson University, Philadelphia, United States. SOURCE Journal of the American Geriatrics Society (2017) 65 Supplement 1 (S168-S169). Date of Publication: 1 May 2017 CONFERENCE NAME 2017 Annual Scientific Meeting of the American Geriatrics Society CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2017-05-18 to 2017-05-20 ISSN 0002-8614 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Background There is little information on how clinicians should and currently approach shared decision-making with older adults about cancer screening. Methods This study involved a survey of primary care providers (PCPs) to gain a better understanding of current approaches with cancer screening in older adults. The survey was administered through an on-line program that allowed participants to remain anonymous and included attending physicians, fellows, residents, and nurse practitioners from the Departments of Family and Community Medicine and Internal Medicine. Results A total of 51 PCPs completed the survey. Table 1 shows the percentage of patients for whom PCPs report recommending screening for breast and colon cancer. 90.2% of PCPs report feeling somewhat or very comfortable discussing reasons for and against screening for cancer with patients age ≥ 75. 86.3% report feeling somewhat or very comfortable recommending that a patient stops cancer-screening. The most important factors that determine whether to order cancer screening for someone age ≥75 include: life expectancy, patient preference, and severity of medical conditions. 78.4% of PCPs report not using tools in practice to assist with decision-making about cancer screening with older adults. PCPs report that the following tools would be helpful: methods for estimating life expectancy (60.8%), decision aids for providers to estimate benefits/harms of cancer screening (64.7%), and decision aids for patients that present personalized benefits/harms of cancer screening (66.7%). Conclusion: Most PCPs reported feeling comfortable discussing reasons for and against cancer screening with their older patients. However, there was a wide variation in reported practice in regards to recommending cancer screening, suggesting a need for more guidance. Many providers do not currently utilize tools to assist with shared decision-making, but would find them helpful. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening female male EMTREE MEDICAL INDEX TERMS adult aged breast cancer cancer epidemiology clinical study colon cancer community medicine doctor patient relation family human internal medicine life expectancy nurse practitioner patient preference primary medical care resident shared decision making LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616116149 DOI 10.1111/imj.13426 FULL TEXT LINK http://dx.doi.org/10.1111/imj.13426 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 6 TITLE Optimal Sequencing of Postmastectomy Radiotherapy and Two Stages of Prosthetic Reconstruction: A Meta-analysis AUTHOR NAMES Lee K.-T. Mun G.-H. AUTHOR ADDRESSES (Lee K.-T.; Mun G.-H., supramicro@gmail.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS G.-H. Mun, Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Email: supramicro@gmail.com SOURCE Annals of Surgical Oncology (2017) 24:5 (1262-1268). Date of Publication: 1 May 2017 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Despite an expanding role of adjuvant radiotherapy and the popularity of two-stage prosthesis-based reconstruction in the treatment of breast cancer, there is no consensus on the proper timing of postmastectomy radiotherapy (PMRT) in relation to the two stages of the reconstruction procedure. The present meta-analysis investigated the optimum timing of PMRT by comparing the outcomes of the following two sequences: radiation on tissue expander followed by the exchange, and radiation on the permanent implant after the exchange. Methods: The Medline, Ovid, and Google Scholar databases were searched to identify relevant studies presenting complication rates of the two sequencings. The relative risks of the adverse outcomes between the groups were calculated. Results: A total of eight studies were analyzed, representing 899 cases. There were no prospective randomized controlled trials, and all but one were retrospective cohorts in nature. The risks for reconstruction failure and major complication requiring reoperation tended to be higher in the group with PMRT to tissue expanders compared to that with PMRT to implants; however, the differences were not significant. The group with PMRT to tissue expanders had a significantly lower risk of severe capsular contracture (relative risk, 0.44; P < 0.001). Conclusions: Delivering PMRT to tissue expanders can reduce the risk of severe capsular contracture compared to delivering to implants. No significant differences in the risks of other complications, including reconstruction failure between the two sequencings, were detected; however, as a result of low level of evidence and insufficient sample sizes, further studies are needed to support evidence-based decision making. EMTREE DRUG INDEX TERMS antineoplastic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast reconstruction breast tissue expander cancer radiotherapy mastectomy postmastectomy radiotherapy EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adverse outcome article bibliographic database breast implant cancer patient cancer surgery disease severity human implant capsular contracture Medline meta analysis postoperative complication postoperative period reoperation risk factor surgical infection surgical risk systematic review treatment failure EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170162034 PUI L614643867 DOI 10.1245/s10434-017-5819-1 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5819-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 7 TITLE Decision aids for people facing health treatment or screening decisions AUTHOR NAMES Stacey D. Légaré F. Lewis K. Barry M.J. Bennett C.L. Eden K.B. Holmes-Rovner M. Llewellyn-Thomas H. Lyddiatt A. Thomson R. Trevena L. AUTHOR ADDRESSES (Stacey D., dstacey@uottawa.ca; Lewis K.) University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Canada. (Stacey D., dstacey@uottawa.ca) Ottawa Hospital Research Institute, Centre for Practice Changing Research, 501 Smyth Rd, Ottawa, Canada. (Légaré F.) CHU de Québec Research Center, Université Laval, Population Health and Optimal Health Practices Research Axis, 10 Rue de l'Espinay, D6-727, Québec City, Canada. (Barry M.J.) Informed Medical Decisions Foundation, Boston, United States. (Bennett C.L.) Ottawa Hospital Research Institute, Clinical Epidemiology Program, Administrative Services Building, 1053 Carling Avenue, Ottawa, Canada. (Eden K.B.) Oregon Health Sciences University, Department of Medical Informatics and Clinical Epidemiology, BICC 535, 3181 S.W. Sam Jackson Park Road, Portland, United States. (Holmes-Rovner M.) Michigan State University College of Human Medicine, Center for Ethics and Humanities in the Life Sciences, East Fee Road, 956 Fee Road, East Lansing, United States. (Llewellyn-Thomas H.) Dartmouth College, The Dartmouth Center for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Hanover, United States. (Lyddiatt A.) 28 Greenwood Road, Ingersoll, Canada. (Thomson R.) Newcastle University, Institute of Health and Society, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, United Kingdom. (Trevena L.) The University of Sydney, Edward Ford Building (A27), Sydney, Australia. CORRESPONDENCE ADDRESS D. Stacey, University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Canada. Email: dstacey@uottawa.ca SOURCE Cochrane Database of Systematic Reviews (2017) 2017:4 Article Number: CD001431. Date of Publication: 12 Apr 2017 ISSN 1469-493X (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Background: Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. Objectives: To assess the effects of decision aids in people facing treatment or screening decisions. Search methods: Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. Selection criteria: We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. Data collection and analysis: Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process. Secondary outcomes were behavioural, health, and health system effects. We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. Main results: We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias. With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care. Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence). Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care. Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care. The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids. In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. Authors' conclusions: Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient decision making EMTREE MEDICAL INDEX TERMS accuracy conflict consultation human outcome assessment patient satisfaction perception priority journal randomized controlled trial (topic) review screening systematic review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170300951 PUI L615579842 DOI 10.1002/14651858.CD001431.pub5 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD001431.pub5 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 8 TITLE A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with single stage implant reconstruction in the treatment of breast cancer AUTHOR NAMES Chatterjee A. Asban A. Chen L. Fisher C. AUTHOR ADDRESSES (Chatterjee A.; Chen L.) Tufts Medical Center, Boston, United States. (Asban A.) University of Alabama, Birmingham, United States. (Fisher C.) Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, United States. CORRESPONDENCE ADDRESS A. Chatterjee, Tufts Medical Center, Boston, United States. SOURCE Annals of Surgical Oncology (2017) 24:2 Supplement 1 (239-240). Date of Publication: 1 Apr 2017 CONFERENCE NAME 18th Annual Meeting of the American Society of Breast Surgeons, ASBS 2017 CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-04-26 to 2017-04-30 ISSN 1534-4681 BOOK PUBLISHER Springer New York LLC ABSTRACT Background/Objective: For larger cancers in moderate- to large-breast sized women, breast surgical cancer treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with single stage implant reconstruction (SSIR). Often in the case of LVOS, reduction mammaplasty designs are used in the oncoplastic reconstructions with a contralateral symmetry operation. The goal of this study was to investigate the cost-utility between LVOS versus SSIR to determine which approach is cost-effective in the treatment of breast cancer. There has been no previous cost nor clinical effectiveness analysis comparing these techniques. Methods: A review of the literature was performed to calculate probabilities for clinical outcomes for each surgical option (LVOS versus SSIR), and to obtain utility scores that were converted into qualityadjusted life years (QALYs) as measures for clinical effectiveness. For a cost assessment pertaining to outcomes in each surgical option, average national Medicare payment rates using DRG and CPT codes were used. Radiation was assumed as adjuvant treatment in the LVOS arm. A decision analysis tree was constructed comparing LVOS to SSIR (Figure 1) into which these probabilities, QALYs, and costs were placed. An incremental cost-utility ratio (ICUR) was calculated comparing the difference for both surgical options in costs by the difference in clinical-effectiveness to see which surgical option was more costeffective. To validate our results, we performed one-way sensitivity analyses in addition to a Monte- Carlo analysis. Results: The decision tree (Figure) shows the associated probabilities, QALYs, and costs for each clinical outcome arising from either the LVOS arm or the SSIR arm. An ICUR of $644/QALY favoring LVOS was calculated based on its clinical-effectiveness gain of 7.11 QALY at an additional cost of $4,579.43 (partly due to the additional costs of radiation treatment and the bilateral operation needed for LVOS compared to no radiation and unilateral surgery for SSIR). This proved that LVOS is a cost-effective surgical option given that a surgical approach is deemed cost-effective if its ICUR is less than $50,000/QALY. One-way sensitivity analyses underscored the degree by which LVOS was cost-effective. For example, LVOS became cost-ineffective when a successful LVOS cost more than $50,000 (more than twice its estimated cost shown in the figure). Similarly, probabilistic sensitivity analysis using Monte- Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the cost-effectiveness of LVOS. Conclusions: For the appropriate patients with moderate- to large-sized breasts with breast cancer, large volume displacement oncoplastic surgery is cost-effective in breast cancer treatment compared to mastectomy with single-staged implant reconstruction. This provides yet another reasonable breast conservation surgical option for the breast cancer patient. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cost utility analysis female implant mastectomy EMTREE MEDICAL INDEX TERMS cancer patient cancer therapy clinical outcome clinical study clinical trial comparative effectiveness controlled study cost effectiveness analysis Current Procedural Terminology decision tree human male medicare Monte Carlo method probability radiation radiotherapy surgery surgical approach LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616338248 DOI 10.1245/s10434-017-5854-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5854-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 9 TITLE Impact of the receipt of pre-consultation web-based material on patients' value-concordant decision-making for type of breast cancer surgery AUTHOR NAMES Tucholka J. Yang D.-Y. Bruce J. Schumacher J. Steiman J. Wilke L. Greenberg C. Neuman H. AUTHOR ADDRESSES (Tucholka J.; Yang D.-Y.; Bruce J.; Schumacher J.; Steiman J.; Wilke L.; Greenberg C.; Neuman H.) University of Wisconsin, School of Medicine and Public Health, Madison, United States. CORRESPONDENCE ADDRESS J. Tucholka, University of Wisconsin, School of Medicine and Public Health, Madison, United States. SOURCE Annals of Surgical Oncology (2017) 24:2 Supplement 1 (150-151). Date of Publication: 1 Apr 2017 CONFERENCE NAME 18th Annual Meeting of the American Society of Breast Surgeons, ASBS 2017 CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-04-26 to 2017-04-30 ISSN 1534-4681 BOOK PUBLISHER Springer New York LLC ABSTRACT Background/Objective: The decision for breast cancer surgery should consider patient preference, and a high-quality decision should be concordant with patients' values. We hypothesized that receipt of a web-based breast cancer surgery decision aid (DA) prior to a surgeon visit would enhance communication between the patient and surgeon by prompting patients to consider their values and preferences a priori. We used a novel implementation strategy to deliver 2 different types of web-based information to patients prior to the surgical consultation, and compared the impact on patients' baseline preferences for surgical type. Methods: We prospectively randomized stage 0-3 breast cancer patients to be emailed a link to a webbased decision aid versus standard web sites (National Cancer Institute, American Cancer Society, Breast cancer.org). Prior to meeting the surgeon, patients completed the Breast Cancer Surgery Decision Quality Instrument, which elicits patients' values relevant to surgical decision-making. Patients were asked their baseline preference for type of surgery. Concordance between patients' values and baseline preference for surgery was calculated by developing a multivariable logistic regression model of their baseline preference for surgery, including the elicited patient values as predictors. The model-predicted probability of a baseline preference for mastectomy versus breast conservation was then calculated for each patient. Patients were considered concordant if they had a stated preference for mastectomy with a predicted probability of ≥ 0.5, or breast conservation with predicted probability of < 0.5. The proportion concordant was compared between the 2 randomization arms using chi-square (and Fisher's exact test where appropriate). Results: Two hundred forty-four patients were randomized and electronically received the web-based material; 222 answered the values and preference questions and are included in this analysis. Participants' median age was 58 (27-80), 99% were white, and 66% had at least a college degree; these demographics were consistent across study arms (p > 0.05). After receiving the web-based material but before meeting the surgeon, 44% of patients reported uncertainty regarding their preferred surgery; 38% stated a preference for breast conservation and 18% for mastectomy (distribution similar across study arms, p=0.4). Patients stated a preference for surgery type concordant with their reported values in 90% of cases. Likelihood of concordance was statistically different between study arms (p=0.04, DA 85% [n=9 discordant] vs standard websites 96% [n=3 discordant]). For those patients that reported uncertainty regarding their baseline preference for surgery, the vast majority (94%, n=89) had a modelpredicted probability based on their values that suggested a strong preference for either mastectomy (23%, n=22) or breast conservation (69%, n=67). Conclusions: In our randomized study, there was a statistically but likely not clinically significant difference in the likelihood of patients having a values-concordant baseline preference for surgery based on the type of web-based information received. Importantly, most patients who state a preference for surgery are doing so in concordance with their values. Although a large proportion of patients stated they were uncertain which surgical procedure they preferred, most answered questions about key values relevant to breast cancer surgery in a way that suggested a baseline preference for type of surgery. Using this type of survey to elicit patients' baseline values and preferences for surgery prior to meeting the surgeon is feasible and may enhance patient-surgeon consultations by providing surgeons important insights into how their patients are approaching decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery consultation decision making doctor patient relation female male EMTREE MEDICAL INDEX TERMS adult aged cancer patient college controlled clinical trial controlled study human logistic regression analysis major clinical study mastectomy national health organization non profit organization probability randomization randomized controlled trial statistical model surgeon surgery surgical technique uncertainty LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616365256 DOI 10.1245/s10434-017-5854-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5854-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 10 TITLE Erratum to: Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study AUTHOR NAMES Yao K. Belkora J. Bedrosian I. Rosenberg S. Sisco M. Barrera E. Kyrillos A. Tilburt J. Wang C. Rabbitt S. Pesce C. Simovic S. Winchester D.J. Sepucha K. AUTHOR ADDRESSES (Yao K., kyao@northshore.org; Sisco M.; Barrera E.; Kyrillos A.; Rabbitt S.; Pesce C.; Simovic S.; Winchester D.J.) Department of Surgery, NorthShore University HealthSystem, Evanston, United States. (Belkora J.) University of California San Francisco School of Medicine, San Francisco, United States. (Bedrosian I.) Department of Surgery, MD Anderson Cancer Center, Houston, United States. (Rosenberg S.) Dana Farber Cancer Institute, Boston, United States. (Tilburt J.) Mayo Clinic, Rochester, United States. (Wang C.) Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, United States. (Sepucha K.) Massachusetts General Hospital, Health Decision Sciences Center, Boston, United States. CORRESPONDENCE ADDRESS K. Yao, Department of Surgery, NorthShore University HealthSystem, Evanston, United States. Email: kyao@northshore.org SOURCE Annals of Surgical Oncology (2017) (1). Date of Publication: 27 Mar 2017 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) pilot study prophylactic mastectomy EMTREE MEDICAL INDEX TERMS human LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170233623 PUI L615056041 DOI 10.1245/s10434-017-5850-2 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5850-2 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 11 TITLE Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis AUTHOR NAMES Ivlev I. Hickman E.N. McDonagh M.S. Eden K.B. AUTHOR ADDRESSES (Ivlev I., ivlev@ohsu.edu; Hickman E.N.; McDonagh M.S.; Eden K.B.) Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, United States. (McDonagh M.S.; Eden K.B.) Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, United States. CORRESPONDENCE ADDRESS I. Ivlev, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, United States. Email: ivlev@ohsu.edu SOURCE Journal of General Internal Medicine (2017) (1-10). Date of Publication: 13 Mar 2017 ISSN 1525-1497 (electronic) 0884-8734 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women’s behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women’s intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA. Methods: We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended. Results: We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04–2.13]; P = 0.03), particularly for younger (38–50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69–89 years) to discontinue screening. Conclusions: The use of BCS-PtDAs increased younger women’s reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38–50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography. Registration: The protocol of this review is registered in the PROSPERO database, #CRD42016036695. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening mammography EMTREE MEDICAL INDEX TERMS adult breast cancer clinical practice controlled study female human language Medline observational study PsycINFO registration Scopus shared decision making systematic review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170192967 PUI L614798953 DOI 10.1007/s11606-017-4027-9 FULL TEXT LINK http://dx.doi.org/10.1007/s11606-017-4027-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 12 TITLE Effect of decision aid for breast cancer prevention on decisional conflict in women with a BRCA1 or BRCA2 mutation: A multisite, randomized, controlled trial AUTHOR NAMES Metcalfe K.A. Dennis C.-L. Poll A. Armel S. Demsky R. Carlsson L. Nanda S. Kiss A. Narod S.A. AUTHOR ADDRESSES (Metcalfe K.A., kelly.metcalfe@utoronto.ca; Dennis C.-L.; Poll A.; Nanda S.; Narod S.A.) Women's College Research Institute, Toronto, Canada. (Metcalfe K.A., kelly.metcalfe@utoronto.ca; Dennis C.-L.; Carlsson L.) Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. (Armel S.; Demsky R.) University Health Network, Toronto, Canada. (Kiss A.) Sunnybrook Research Institute, Toronto, Canada. CORRESPONDENCE ADDRESS K.A. Metcalfe, Women's College Research Institute, Toronto, Canada. Email: kelly.metcalfe@utoronto.ca SOURCE Genetics in Medicine (2017) 19:3 (330-336). Date of Publication: 1 Mar 2017 ISSN 1530-0366 (electronic) 1098-3600 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Purpose:Women with a BRCA1 or BRCA2 mutation are at high risk for breast cancer and must make important decisions about breast cancer prevention and screening. In the current study, we report a multisite, randomized, controlled trial evaluating the effectiveness of a decision aid for breast cancer prevention in women with a BRCA mutation with no previous diagnosis of cancer.Methods:Within 1 month of receiving a positive BRCA result, women were randomized to receive either usual care (control group) or decision aid (intervention group). Participants were followed at 3, 6, and 12 months; were asked about preventive measures; and completed standardized questionnaires assessing decision making and psychosocial functioning.Results:One hundred fifty women were randomized. Mean cancer-related distress scores were significantly lower in the intervention group compared with the control group at 6 months (P = 0.01) and at 12 months postrandomization (P = 0.05). Decisional conflict scores declined over time for both groups and at no time were there statistical differences between the two groups.Conclusion:The decision aid for breast cancer prevention in women with a BRCA1 or BRCA2 mutation is effective in significantly decreasing cancer-related distress within the year following receipt of positive genetic test results. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, prevention) cancer prevention clinical decision support system distress syndrome (therapy) patient decision making EMTREE MEDICAL INDEX TERMS article attitude to health clinical effectiveness conflict controlled study female gene mutation genetic counseling genetic screening human major clinical study multicenter study prophylactic mastectomy randomized controlled trial risk reduction social psychology CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Psychiatry (32) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170188217 PUI L614765165 DOI 10.1038/gim.2016.108 FULL TEXT LINK http://dx.doi.org/10.1038/gim.2016.108 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 13 TITLE Influence of the SSO/ASTRO Margin Reexcision Guidelines on Costs Associated with Breast-Conserving Surgery AUTHOR NAMES Baliski C.R. Pataky R.E. AUTHOR ADDRESSES (Baliski C.R., cbaliski@bccancer.bc.ca) Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, Canada. (Baliski C.R., cbaliski@bccancer.bc.ca) Department of Surgery, University of British Columbia, Vancouver, Canada. (Pataky R.E.) Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, Canada. CORRESPONDENCE ADDRESS C.R. Baliski, Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, Canada. Email: cbaliski@bccancer.bc.ca SOURCE Annals of Surgical Oncology (2017) 24:3 (632-637). Date of Publication: 1 Mar 2017 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: The reported reexcision rates vary significantly for patients with invasive breast cancer undergoing breast-conserving surgery (BCS). This variability is a function of both the positive pathologic margin rate and the interpretation of an adequate pathologic margin. The influence of the SSO/ASTRO margin guidelines on reexcision rates and the potential cost savings is of interest from both quality and health economics perspectives. Methods: A retrospective analysis of all patients undergoing BCS during a 3-year period (January 1, 2010–December 31, 2012) was performed. The reexcision rate and the pathologic margin status were assessed to determine the number of patients with pathologic negative margins who underwent reexcision. A decision analysis using previously published case costing information was used to determine the potential savings associated with avoidance of reoperation for patients meeting guidelines criteria. Results: The analysis included 512 patients who underwent attempted BCS for invasive breast cancer. Reoperations occurred for 25% (126/512) of the BCS cohort, but this rate could potentially be decreased to 16% (44/512) if these guidelines were applied. Based on our cost model, application of the guidelines would provide a potential cost savings of $698 (95% confidence interval $523–$893) per patient undergoing attempted BCS in our population. Conclusions: Adherence to the SSO-ASTRO guidelines could prevent one-third of reoperations among patients undergoing BCS. This would result in significant cost savings to the health care system while avoiding unnecessary operations. Use of guidelines has the potential to improve the quality of care provided to patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) cost control health care cost partial mastectomy reoperation EMTREE MEDICAL INDEX TERMS adult article breast carcinoma (disease management, surgery) cancer patient cancer surgery clinical assessment confidence interval controlled study decision tree excision female health care organization health care quality health economics human intraductal carcinoma (disease management, surgery) major clinical study mastectomy practice guideline surgical patient young adult EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160862178 PUI L613408931 DOI 10.1245/s10434-016-5678-1 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-016-5678-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 14 TITLE Shared decision-making approach in breast reconstruction in a developing country AUTHOR NAMES Maciel-Miranda A. Gutierrez-Zacarias L.M. Cabrera-Galeana P.A. Bargallo-Rocha E. AUTHOR ADDRESSES (Maciel-Miranda A.; Gutierrez-Zacarias L.M.; Cabrera-Galeana P.A.; Bargallo-Rocha E.) CORRESPONDENCE ADDRESS A. Maciel-Miranda, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background In Mexico breast cancer is the leading cause of cancer mortality in women. The goal of reconstruction is restoration of patient's quality of life after cancer, including concerns about body image, sexuality, self-esteem and social life. Reconstruction is one of the most important determinants of long-term health. Autologous reconstruction has been found to offer a better satisfaction in the long term, even these findings, a paradigm shift toward implant reconstruction has been described previously. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together. It takes into account the best clinical evidence available, as well as the patient's values and preferences. In medical treatments where several options have been found, SDM has been a useful tool, increasing patient's satisfaction and better outcomes. Through this process of informing and involving the patient, high-quality decisions that align with patient preferences are achievable. Methods Evaluation of particular case was made, with personalized approach depending on breast cancer stage and mastectomy type planned. On first consultation basic information about different techniques was offered: pros and cons on surgical time, recovery time, long term complications, sensation and physical appearence. We offered a second consultation if the patient wanted to go deeper in the information we presented, or even is she wanted to look out for more information on the internet and other sources. When an abdominal free flap was planned, we saw the patient in a second consultation to review the CT-angio, and to establish the definitive flap option. For risk estimation we used www.brascore.org website, and talk about it with the patient. Then patient and plastic surgeon made decision on breast reconstruction technique. BREAST-Q questionnaries were applied in pre and postoperative setting. Results From 06/2014 to 06/2016 we performed 150 breast reconstructions with this SDM approach with the following techniques: 64% expander, 15% direct to implant, 1 1% DIEP flap, 6% lattisimus dorsi flap, 3% Becker implant, 1 % TRAM flap. BREAST-Q questionnaries showed 100% think breast reconstruction is better than do not reconstruct, and 100% would recommend reconstructive surgery. 91.7% felt included in the decision process. Satisfaction with breast (preoperative vs postoperative) 66.21 vs 81.13, Satisfaction with outcome 85.06, Psychosocial well being 80.75 vs 88.35, Physical well-being 74.92 vs 68.73, Sexual well-being 66.66 vs 72.84, Satisfaction with information 86.86, Satisfaction with surgeon 98.73, Satisfaction with medical staff 96.2. Analysis Implant based reconstruction (82%) was prefered due to: simplicity, less overall risk, and giving more importance to cancer treatment and leaving reconstruction in second place. It could also be a short-term vision regarding benefits, in spite of shared information. Aesthetic improvement of the abdominal area seems to be a factor to decide for autologous abdominal flap among young adult women (7%). Possibility of pregnancy should be considered among young women. In our breast reconstruction program for young women with breast cancer, egg preservation is offered, so abdominal flaps should be delayed after a possible pregnancy. We need to encourage SDM in breast reconstruction. We need information systems available to patients prior to breast reconstruction like educational meetings, giving healthcare professionals feedback, giving healthcare professionals learning materials, and using patient decision aids. Shared decisions leads to better outcomes and high patient's satisfaction in breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction developing country shared decision making EMTREE MEDICAL INDEX TERMS adult body image breast cancer cancer mortality cancer staging cancer therapy case report complication consultation deep inferior epigastric perforator flap doctor patient relation female free tissue graft human implant information system Internet learning mastectomy medical staff Mexico patient preference patient satisfaction physical well-being plastic surgeon pregnancy quality of life reconstructive surgery self esteem sexuality social life surgery transverse rectus abdominis musculocutaneous flap vision young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062823 DOI 10.1158/1538-7445.SABCS16-P3-14-10 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P3-14-10 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 15 TITLE Decision support intervention for breast reconstruction following mastectomy: Developing and testing the option grid AUTHOR NAMES Flannagan C. Mccaughan E. Winder J. McIntosh S. Lloyd A. Durand M.-A. Glyn E. AUTHOR ADDRESSES (Flannagan C.; Mccaughan E.; Winder J.) Ulster University, United Kingdom. (McIntosh S.) Queens University Belfast, United Kingdom. (Lloyd A.; Durand M.-A.; Glyn E.) Option Grid Collaboration, United Kingdom. CORRESPONDENCE ADDRESS E. Mccaughan, Ulster University, United Kingdom. SOURCE Psycho-Oncology (2017) 26 Supplement 1 (102). Date of Publication: 1 Feb 2017 CONFERENCE NAME 14th Annual Conference of the American Psychosocial Oncology Society, APOS 2017 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2017-02-16 to 2017-02-18 ISSN 1099-1611 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Purpose: Post mastectomy breast reconstruction is an elective procedure offered to women as part of surgical treatment for breast cancer. Choosing to have a reconstruction or not, and when, is a challenging decision for women in an emotive environment. Decision support interventions (DSIs) have proved beneficial in enabling shared decision- making with patients and clinicians in similar situations of clinical equipoise. The implementation of DSIs into routine clinical practice has proved challenging. The project, conducted over two phases, included the development of a breast reconstruction DSI and on the feasibility of implementing a DSI in the clinical environment. Methods: Women's decision making was examined through a thematic analysis of interviews with breast cancer survivors and a literature review. A collaborative development framework and iterative process were utilised to design the breast reconstruction DSI. The DSI was introduced into the clinical environment to identify potential barriers and facilitators to implementation. A case study approach, including the decisional conflict scale and qualitative methods, examined the perceptions and experience of the patients and clinicians. Results: The Breast Reconstruction Option Grid DSI was published online as part of the Option Grid Collaborative. In feasibility testing, its flexibility and accessibility were positive features in terms of its implementation. The content and format facilitated the comparison of options. The timing of when it was introduced impacted its effect on patient decision making. Conclusions: The Option Grid DSI can be integrated into routine clinical practice and gave some consultations more structure. Patient participants in the feasibility study found it constructive in facilitating their decision making. The sample cohort only represented women who chose an immediate reconstruction as part of their surgical treatment. Given this limitation and the significance of local support from key stakeholders, we warrant further testing with a potentially wider audience. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision support system mastectomy EMTREE MEDICAL INDEX TERMS breast cancer cancer survivor clinical practice clinical study consultation feasibility study female human human tissue interview patient decision making perception qualitative analysis thematic analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L615274981 DOI 10.1002/pon.4354 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4354 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 16 TITLE Changes of tumor-infiltrating lymphocytes and programmed death-ligand1 positivity after neoadjuvant chemotherapy in patients with locally advanced breast cancer AUTHOR NAMES Choi Y.J. Lee J.H. Moon S.Y. Choi J.Y. Jung S.P. Bae J.W. Park K.H. AUTHOR ADDRESSES (Choi Y.J.; Lee J.H.; Moon S.Y.; Choi J.Y.; Jung S.P.; Bae J.W.; Park K.H.) CORRESPONDENCE ADDRESS Y.J. Choi, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background In Mexico breast cancer is the leading cause of cancer mortality in women. The goal of reconstruction is restoration of patient's quality of life after cancer, including concerns about body image, sexuality, self-esteem and social life. Reconstruction is one of the most important determinants of long-term health. Autologous reconstruction has been found to offer a better satisfaction in the long term, even these findings, a paradigm shift toward implant reconstruction has been described previously. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together. It takes into account the best clinical evidence available, as well as the patient's values and preferences. In medical treatments where several options have been found, SDM has been a useful tool, increasing patient's satisfaction and better outcomes. Through this process of informing and involving the patient, high-quality decisions that align with patient preferences are achievable. Methods Evaluation of particular case was made, with personalized approach depending on breast cancer stage and mastectomy type planned. On first consultation basic information about different techniques was offered: pros and cons on surgical time, recovery time, long term complications, sensation and physical appearence. We offered a second consultation if the patient wanted to go deeper in the information we presented, or even is she wanted to look out for more information on the internet and other sources. When an abdominal free flap was planned, we saw the patient in a second consultation to review the CT-angio, and to establish the definitive flap option. For risk estimation we used www.brascore.org website, and talk about it with the patient. Then patient and plastic surgeon made decision on breast reconstruction technique. BREAST-Q questionnaries were applied in pre and postoperative setting. Results From 06/2014 to 06/2016 we performed 150 breast reconstructions with this SDM approach with the following techniques: 64% expander, 15% direct to implant, 11% DIEP flap, 6% lattisimus dorsi flap, 3% Becker implant, 1% TRAM flap. BREAST-Q questionnaries showed 100% think breast reconstruction is better than do not reconstruct, and 100% would recommend reconstructive surgery. 91.7% felt included in the decision process. Satisfaction with breast (preoperative vs postoperative) 66.21 vs 81.13, Satisfaction with outcome 85.06, Psychosocial well being 80.75 vs 88.35, Physical well-being 74.92 vs 68.73, Sexual well-being 66.66 vs 72.84, Satisfaction with information 86.86, Satisfaction with surgeon 98.73, Satisfaction with medical staff 96.2. Analysis Implant based reconstruction (82%) was prefered due to: simplicity, less overall risk, and giving more importance to cancer treatment and leaving reconstruction in second place. It could also be a short-term vision regarding benefits, in spite of shared information. Aesthetic improvement of the abdominal area seems to be a factor to decide for autologous abdominal flap among young adult women (7%). Possibility of pregnancy should be considered among young women. In our breast reconstruction program for young women with breast cancer, egg preservation is offered, so abdominal flaps should be delayed after a possible pregnancy. Conclusions We need to encourage SDM in breast reconstruction. We need information systems available to patients prior to breast reconstruction like educational meetings, giving healthcare professionals feedback, giving healthcare professionals learning materials, and using patient decision aids. Shared decisions leads to better outcomes and high patient's satisfaction in breast reconstruction. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) programmed death 1 ligand 1 EMTREE DRUG INDEX TERMS endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant chemotherapy breast cancer tumor associated leukocyte EMTREE MEDICAL INDEX TERMS adult body image breast reconstruction cancer mortality cancer staging cancer therapy case report complication consultation deep inferior epigastric perforator flap doctor patient relation female free tissue graft human implant information system Internet learning mastectomy medical staff Mexico patient preference patient satisfaction physical well-being plastic surgeon pregnancy quality of life reconstructive surgery self esteem sexuality shared decision making social life surgery transverse rectus abdominis musculocutaneous flap vision young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062684 DOI 10.1158/1538-7445.SABCS16-P2-04-24 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P2-04-24 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 17 TITLE Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer AUTHOR NAMES Zdenkowski N. Herrmann A. Hall A. Boyle F.M. Butow P. AUTHOR ADDRESSES (Zdenkowski N.; Herrmann A.; Hall A.; Boyle F.M.; Butow P.) CORRESPONDENCE ADDRESS N. Zdenkowski, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST. Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged >18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid. Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST. Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently.Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up-front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST. Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged >18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid. Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST. Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer systemic therapy EMTREE MEDICAL INDEX TERMS adult anxiety cancer diagnosis cancer patient case report consultation convenience sample decision making diagnosis doctor patient relation family feasibility study female grounded theory human interview married person middle aged patient participation qualitative analysis quality of life quantitative analysis satisfaction staging statistics surgeon surgery university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616063359 DOI 10.1158/1538-7445.SABCS16-P3-11-02 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P3-11-02 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 18 TITLE High-throughput genome analysis and therapeutic decision for patients with HER2-negative metastatic breast cancer: First feasibility and molecular results of the randomized phase II study SAFIR02 BREAST (UCBG-0105/1304) AUTHOR NAMES Goncalves A. Bachelot T. Lusque A. Arnedos M. Campone M. Bieche I. Lacroix L. Pierron G. Dalenc F. Filleron T. Sablin M.-P. Jimenez M. Ferrero J.-M. Lefeuvre-Plesse C. Bonnefoi H. Attignon V. Soubeyran I. Jezequel P. Commo F. Andre F. AUTHOR ADDRESSES (Goncalves A.; Bachelot T.; Lusque A.; Arnedos M.; Campone M.; Bieche I.; Lacroix L.; Pierron G.; Dalenc F.; Filleron T.; Sablin M.-P.; Jimenez M.; Ferrero J.-M.; Lefeuvre-Plesse C.; Bonnefoi H.; Attignon V.; Soubeyran I.; Jezequel P.; Commo F.; Andre F.) CORRESPONDENCE ADDRESS A. Goncalves, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background A genomic-driven therapeutic strategy in metastatic breast cancer (MBC) was recently demonstrated as feasible in the clinical practice, but its actual impact on patient outcome remains elusive. SAFIR02 study is an ongoing national multicentric phase II randomized trial evaluating targeted therapies matching specific genomic alterations (GA) administered as maintenance after objective response and/or stable disease obtained with chemotherapy in HER2-negative MBC patients. This analysis reports on feasibility of the procedure and the rate of identified actionable targets. Methods Eligible MBC patients (PS=0/1, first-or second-line of chemotherapy, HER2-negative/hormone receptor (HR)-negative or endocrine resistant HR-positive; measurable per RECIST 1.1; accessible to tumor biopsy; no bone metastases-only disease, no major organ dysfunction) were subjected to tumor biopsy for genomic analysis (CGH arrays, Affymetrix Cytoscan; NGS, Ion Torrent PGM, AmpliSeq, panel of around 50 genes). Actionable GA were identified and corresponding targeted therapies were proposed by a multidisciplinary tumor board (MTB). Patients received cytotoxic-based treatment at physician's choice and those with stable or responding disease after 6 to 8 cycles (or at least 4 if stopped for toxicity reason) and targetable GA, were offered randomization between targeted therapy or chemotherapy maintenance until progression or intolerance (main study). Since January 2016, an amendment was made to propose to patients without targetable alteration a randomization between anti-PD-L1 (MEDI4736) or standard chemotherapy maintenance (substudy). Results Between March 2014 and May 2016, 457 patients have been enrolled at 21 centers. Genomic analyses could not be obtained in 107 cases (23%) due to either biopsy failure (n= 40; 9%) or low cellularity (n=67; 14%). Of the 307 patients reviewed by the MTB, 197 (64%) had an actionable GA, including PIK3CA-PIK3CB-PIK3R1 (n=51j, FGF4 or FGFR1/2 (n= 42), BRCA1/2 (n=15), AKT1/2/3 (n=13), BRAF/KRAS/NRAS (n=13), HER2/3 (n=10), NF1-FRS2 (n=10), MTOR-RPTOR-TSC2 (n=8), PTEN (n=7), STK11 (n=7), IGF1R (n=7), EGFR (n=5). Therapeutic proposals by MTB included AZD5363 (n=71), AZD4547 (n=42), AZD2014 (n=23), selumetinib (n=23), olaparib (n=16), AZD8931 (n=15), vandetanib (n=5), bicalutamide (n=2). In an exploratory analysis involving 157 patients, the rate of targeted therapy proposal by MTB markedly differed between triple-negative patients (TNBC; 24 of 48, 50%) and HER2-negative/HR-positive patients (92 of 109, 84%; p=6.14. 10”(6), Chi-2 test). At the time of the analysis, 85 patients have been randomized (main study, 68; substudy, 17). Causes of randomization failure (n=108) included disease progression (n=45) or death (n=25), non-eligibility criteria (n=27), patient/physician's decision (n=11). Conclusion A large number of patients had identified targetable GA. Of note, the rate of targeted therapeutic proposal was significantly lower in TNBC than in HER2-negative/HR-positive patients. Rapidly progressing disease may impede ultimate randomization. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) epidermal growth factor receptor 2 EMTREE DRUG INDEX TERMS 4 amino n [1 (4 chlorophenyl) 3 hydroxypropyl] 1 (7h pyrrolo[2,3 d]pyrimidin 4 yl) 4 piperidinecarboxamide azd 4547 B Raf kinase bicalutamide BRCA1 protein BRCA2 protein durvalumab endogenous compound epidermal growth factor receptor fibroblast growth factor receptor 1 fibroblast growth factor receptor 2 hormone receptor ion K ras protein mammalian target of rapamycin olaparib phosphatidylinositol 3,4,5 trisphosphate 3 phosphatase programmed death 1 ligand 1 protein kinase B protein kinase LKB1 sapitinib selumetinib somatomedin C receptor tuberin vandetanib vistusertib EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) feasibility study female genome analysis male metastatic breast cancer EMTREE MEDICAL INDEX TERMS bone metastasis cancer patient chemotherapy chi square test clinical trial controlled clinical trial controlled study death disease course doctor patient relation drug therapy endocrine system exploratory research human human tissue major clinical study molecularly targeted therapy oncogene N ras organ culture randomization randomized controlled trial response evaluation criteria in solid tumors toxicity triple negative breast cancer tumor biopsy CAS REGISTRY NUMBERS 4 amino n [1 (4 chlorophenyl) 3 hydroxypropyl] 1 (7h pyrrolo[2,3 d]pyrimidin 4 yl) 4 piperidinecarboxamide (1143532-39-1) bicalutamide (90357-06-5) durvalumab (1428935-60-7) epidermal growth factor receptor (79079-06-4) epidermal growth factor receptor 2 (137632-09-8) olaparib (763113-22-0) phosphatidylinositol 3,4,5 trisphosphate 3 phosphatase (210488-47-4) protein kinase B (148640-14-6) sapitinib (848942-61-0) selumetinib (606143-52-6, 865610-79-3, 943332-08-9) vandetanib (338992-00-0, 338992-48-6, 443913-73-3) vistusertib (1009298-59-2) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616063713 DOI 10.1158/1538-7445.SABCS16-PD1-08 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-PD1-08 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 19 TITLE Clinical value of (89)Zr-trastuzumab PET in HER2-positive breast cancer patients with a clinical dilemma PET in HER2-positive breast cancer patients with a clinical dilemma AUTHOR NAMES Schröder C.P. Bensch F. Brouwers A.H. Lub-De Hooge M.N. De Jong J.R. Van Der Vegt B. Sleijfer S. De Vries E.G. AUTHOR ADDRESSES (Schröder C.P.; Bensch F.; Brouwers A.H.; Lub-De Hooge M.N.; De Jong J.R.; Van Der Vegt B.; Sleijfer S.; De Vries E.G.) CORRESPONDENCE ADDRESS C.P. Schröder, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Information on human epidermal growth factor receptor 2 (HER2) is essential for management of metastatic breast cancer (mBC). In patients suspected of HER2-positive mBC, standard work up may fail to clarify whole body HER2 status. We aimed to assess whether (89)Zr-trastuzumab PET can support treatment decisions in patients posing this clinical dilemma. Methods: (89)Zr-trastuzumab PET was performed as described earlier (Gaykema et al, Clin Cancer Res 2014) in patients in whom standard work up with bone scan, FDG PET, CT and if feasible a biopsy, failed to evaluate HER2 status of their disease. (89)Zr-trastuzumab PET was defined positive, when at least a dominant part of the tumor load showed substantial tracer uptake (Gebhart et al, Ann Oncol 2015), when tumor tracer uptake in single lesions (except brain) was ≥ normal liver uptake or when brain metastases had a tracer uptake > background. Circulating tumor cell (CTC) analysis prior to tracer injectionwas performed using the CellSearch System (Janssen Diagnostics LLC) and CTC HER2 status was assessed immunofluorescently. Questionnaires about treatment decisions were completed before, directly after and ≥3 months after (89)Zr-trastuzumab PET. Results: Twenty patients were enrolled: 8 with two primary cancers (HER2-positive and HER2-negative BC or BC and non-BC), 7 with metastases inaccessible for biopsy, 4 with prior HER2-positive and HER2-negative metastases, 1 with primary BC with equivocal HER2 status (average 4.23 HER2 gene copies/nucleus). (89)Zr-trastuzumab PET was positive in 12 patients, negative in 7 and equivocal in one patient. In 15/20 patients (89)Zr-trastuzumab PET supported treatment decision. The scan altered treatment of 8 patients, increased physicians' confidence without affecting treatment in 10, and improved physicians' understanding of disease in 18 patients. Ten patients had 1-99 CTCs, 6 with HER2 expression. There was no correlation between HER2 expression by CTCs and (89)Zr-trastuzumab PET results or subsequent treatment decision. Conclusion: (89)Zr-trastuzumab PET, but not CTC analysis, supports clinical decision making in BC patients in whom standard work up fails to evaluate HER2 status. (Funded by the Dutch A Sister's Hope). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) trastuzumab zirconium 89 EMTREE DRUG INDEX TERMS endogenous compound epidermal growth factor receptor 2 tracer unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient human epidermal growth factor receptor 2 positive breast cancer EMTREE MEDICAL INDEX TERMS biopsy bone scintiscanning brain metastasis circulating tumor cell clinical article clinical decision making clinical trial doctor patient relation drug therapy female gene expression human human tissue immunofluorescence liver positron emission tomography-computed tomography primary tumor questionnaire sister treatment failure CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) trastuzumab (180288-69-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616063525 DOI 10.1158/1538-7445.SABCS16-P5-03-06 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P5-03-06 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 20 TITLE Risk of metachronous contralateral breast cancer: Systematic review and meta-analysis AUTHOR NAMES Akdeniz D. Schmidt M.K. McCool D. Van Den Broek A.J. Hauptmann M. Seynaeve C.M. Steyerberg E.W. Hooning M.J. AUTHOR ADDRESSES (Akdeniz D.; Schmidt M.K.; McCool D.; Van Den Broek A.J.; Hauptmann M.; Seynaeve C.M.; Steyerberg E.W.; Hooning M.J.) CORRESPONDENCE ADDRESS D. Akdeniz, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction Over the last 2 decades, an increasing number of primary breast cancer (PBC) patients opted for a risk reducing contralateral mastectomy, to minimize risk of subsequent contralateral breast cancer (CBC). Therefore, accurate risk estimates of CBC are important for patient tailored counseling and decision making regarding treatment. Currently, CBC risk estimates are determined by BRCA1/2 mutation status, age at PBC diagnosis and family history. For other risk factors, results are inconclusive. We therefore aimed to quantify the association with CBC risk for patient, tumor and treatment related factors as reported in the literature. Methods Medline was searched for publications on CBC risk by one reviewer (DA). We focused on associations between CBC risk and BRCA1/2 and CHEK2∗1100delC mutations, SNPs, risk-reducing salpingo-oophorectomy and various factors at PBC diagnosis: family history of breast cancer (BC), age, BMI, menopausal status, mammographic density, TNM-stage, receptor status, morphology, administered radiotherapy and adjuvant systemic treatment. Eligible papers were published in English between 01-01-1990 and 01-04-2015, investigated female patients with invasive early BC and reported relative risk (RR) estimates (i.e., hazard ratios, relative risks or odds ratios). We combined RR estimates using a random effects model. Heterogeneity was assessed using the I(2) statistic. Forest plots for crude and adjusted estimates were generated stratifying for mutation status (i.e., BRCA1, BRCA2, CHEK2∗1100delC), non-carriers and unselected patients (i.e., population/hospital based cohorts). Results After screening of 1,423 papers for title and abstract, 173 eligible papers were fully read, and 96 papers fulfilled the inclusion criteria. Both in the unselected group and in the BRCA1 and BRCA2 groups, administration of adjuvant endocrine therapy (vs. not), was associated with decreased CBC risk (RR, 0.62 (95% CI 0.55-0.69), 0.55 (95% CI 0.39-0.77), and 0.62 (95% CI 0.40-0.95), respectively). Adjuvant chemotherapy was associated with reduced CBC risk in unselected patients (RR 0.73; 95% CI 0.62-0.86). CBC risk was increased in unselected patients who received radiotherapy at age<40 years (vs. not) (RR 1.33; 95% CI 1.18-1.49), had a lobular (vs. ductal) PBC (RR 1.70; 95% CI 1.33-2.16), had a T2/T3 (vs. T1) PBC (RR 1.15; 95%CI 1.01-1.30), with BMI >30 (vs. <25) at PBC (RR 1.50; 95% CI 1.27-1.76) or had a positive family history for BC (vs. not) (RR 1.82; 95% CI 1.35-2.46). For the other factors of interest we did not observe any effects on CBC risk. For CHEK2∗1100delC mutation carriers and non-carriers, information on factors affecting CBC risk was scarce. In non-carriers, the RR for adjuvant chemotherapy was 0.60 (95% CI 0.53-0.68). Conclusions In unselected patients, adjuvant systemic treatment for PBC decreases CBC risk while a lobular morphology of PBC, high BMI, and a family history of BC increase the risk of CBC. Data is scarce for carriers of a BRCA1/2 or CHEK2∗1100delC mutation and non-carriers. This review identifies prognostic factors to consider for individualized CBC risk estimation which may support medical decision making in BC patients. EMTREE DRUG INDEX TERMS adjuvant BRCA1 protein BRCA2 protein checkpoint kinase 2 endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy body mass breast density cancer patient cancer risk cancer staging disease carrier family study female forest gene mutation genetic susceptibility hazard ratio hormonal therapy human human tissue medical decision making Medline model morphology odds ratio publication quantitative study radiotherapy risk factor salpingooophorectomy screening systematic review CAS REGISTRY NUMBERS checkpoint kinase 2 (244634-79-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616063541 DOI 10.1158/1538-7445.SABCS16-P2-07-05 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P2-07-05 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 21 TITLE Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study AUTHOR NAMES Yao K. Belkora J. Bedrosian I. Rosenberg S. Sisco M. Barrera E. Kyrillios A. Tilburt J. Wang C. Rabbitt S. Pesce C. Simovic S. Winchester D.J. Sepucha K. AUTHOR ADDRESSES (Yao K., kyao@northshore.org; Sisco M.; Barrera E.; Kyrillios A.; Rabbitt S.; Pesce C.; Simovic S.; Winchester D.J.) Department of Surgery, NorthShore University HealthSystem, Evanston, United States. (Belkora J.) University of California San Francisco School of Medicine, San Francisco, United States. (Bedrosian I.) Department of Surgery, MD Anderson Cancer Center, Houston, United States. (Rosenberg S.) Dana Farber Cancer Institute, Boston, United States. (Tilburt J.) Mayo Clinic, Rochester, United States. (Wang C.) Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, United States. (Sepucha K.) Massachusetts General Hospital, Health Decision Sciences Center, Boston, United States. CORRESPONDENCE ADDRESS K. Yao, Department of Surgery, NorthShore University HealthSystem, Evanston, United States. Email: kyao@northshore.org SOURCE Annals of Surgical Oncology (2017) 24:1 (91-99). Date of Publication: 1 Jan 2017 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM. Methods: We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as “low” (≤3 correct) versus “high” (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %). Results: Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had “low” knowledge. Conclusions: Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) pilot study prophylactic mastectomy EMTREE MEDICAL INDEX TERMS anxiety cancer staging controlled study doctor patient relation family study human major clinical study race surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160687261 PUI L612328224 DOI 10.1245/s10434-016-5556-x FULL TEXT LINK http://dx.doi.org/10.1245/s10434-016-5556-x COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 22 TITLE The psychosocial impact of contralateral risk reducing mastectomy (CRRM) on women: A rapid review AUTHOR NAMES Collins K. Gee M. Clack A. Wyld L. AUTHOR ADDRESSES (Collins K., k.collins@shu.ac.uk; Gee M.; Clack A.) Centre for Health and Social Care Research, Faculty of Health and Wellbeing Sheffield Hallam University Sheffield UK (Wyld L.) Academic Unit of Surgical Oncology, Department of Oncology and Metabolism University of Sheffield Medical School Sheffield UK CORRESPONDENCE ADDRESS K. Collins, Centre for Health and Social Care Research, Faculty of Health and Wellbeing Sheffield Hallam University Sheffield UK Email: k.collins@shu.ac.uk SOURCE Psycho-Oncology (2017). Date of Publication: 2017 ISSN 1099-1611 (electronic) 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Objectives: For women who have been diagnosed with unilateral breast cancer, there is an increasing trend for them to request removal of the contralateral healthy breast, the so-called contralateral risk reducing mastectomy (CRRM). The current literature is only just beginning to identify patient-reported reasons for undergoing CRRM and associated patient-reported outcomes. It is also unclear whether women at moderate/high risk of developing a subsequent primary contralateral breast cancer report similar outcomes to those considered to be at low/average risk. This lack of knowledge provides the rationale for this review. Methods: A rapid review methodology was undertaken to identify and explore the published research literature focused on the longer term (>5 y) psychosocial impacts on women who undergo CRRM. Results: Fifteen studies were identified. No UK studies were identified. High satisfaction and psychosocial well-being were consistently reported across all studies. Reducing the risk of a subsequent contralateral breast cancer and therefore reducing cancer-related anxiety, and satisfaction with cosmesis, were key themes running across all studies explaining satisfaction. Dissatisfaction was associated with adverse effects such as poor cosmesis, body image changes, femininity, sexual relationships, reoperations for acute and longer term complications, and reconstructive problems. Conclusions: Satisfaction and psychological well-being following CRRM was consistently high across all studies. However, the findings suggest women need to be more fully informed of the risks and benefits of CRRM and/or immediate/delayed reconstruction to support informed decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy oncology EMTREE MEDICAL INDEX TERMS anxiety body image cancer susceptibility decision making esthetic surgery female femininity human human experiment psychological well-being reoperation running satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170396122 PUI L616557579 DOI 10.1002/pon.4448 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4448 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 23 TITLE Qualitatively understanding patients' and health professionals' experiences of the BRECONDA breast reconstruction decision aid AUTHOR NAMES Sherman K.A. Shaw L.-K. Jørgensen L. Harcourt D. Cameron L. Boyages J. Elder E. Kirk J. Tucker K. AUTHOR ADDRESSES (Sherman K.A., kerry.sherman@mq.edu.au; Shaw L.-K.) Centre for Emotional Health, Department of Psychology Macquarie University Sydney Australia (Sherman K.A., kerry.sherman@mq.edu.au; Elder E.) Westmead Breast Cancer Institute, Westmead Hospital University of Sydney Sydney Australia (Jørgensen L.) Clinic for Surgery and Oncology and Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark (Harcourt D.) Centre for Appearance Research, Faculty of Health and Applied Sciences University of the West of England Bristol UK (Cameron L.) Psychological Sciences University of California Merced, CA USA (Cameron L.) School of Psychology The University of Auckland Auckland New Zealand (Boyages J.) Department of Clinical Medicine, Faculty of Medicine and Health Sciences Macquarie University Sydney Australia (Kirk J.) Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney Medical School University of Sydney Sydney Australia (Kirk J.) Centre for Cancer Research The Westmead Institute for Medical Research Sydney Australia (Tucker K.) Hereditary Cancer Clinic Prince of Wales Hospital Sydney Australia CORRESPONDENCE ADDRESS K.A. Sherman, Centre for Emotional Health, Macquarie University, Sydney, Australia Email: kerry.sherman@mq.edu.au SOURCE Psycho-Oncology (2017). Date of Publication: 2017 ISSN 1099-1611 (electronic) 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Objective: Women diagnosed with breast cancer or ductal carcinoma in situ and those with a genetic susceptibility to developing this disease face the challenging decision of whether or not to undergo breast reconstruction following mastectomy. As part of a large randomized controlled trial, this qualitative study examined women's experiences of using the Breast RECONstruction Decision Aid (BRECONDA) and health professionals' feedback regarding the impact of this resource on patients' knowledge and decision making about breast reconstruction. Method: Semistructured interviews were conducted with women who accessed the BRECONDA intervention (N = 36) and with their healthcare providers (N = 6). All interviews were transcribed verbatim and subjected to thematic analysis by 3 independent coders. Results: Participants reported an overall positive impression, with all interviewees endorsing this decision aid as a useful resource for women considering reconstructive surgery. Thematic analysis of patient interviews revealed 4 themes: overall impressions and aesthetics; personal relevance and utility; introducing BRECONDA; and advantages and suggested improvements. Analysis of health professionals' interviews also revealed 4 themes: need for BRECONDA, impact of BRECONDA, potential difficulties that may arise in using the decision aid, and recommending BRECONDA to patients. Patients indicated that they derived benefit from this resource at all stages of their decision-making process, with the greatest perceived benefit being for those early in their breast reconstruction journey. Conclusion: These findings support the use of BRECONDA as an adjunct to clinical consultation and other information sources. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction doctor patient relation malignant neoplasm oncology EMTREE MEDICAL INDEX TERMS clinical article consultation decision making DNA transcription female health care personnel human reconstructive surgery semi structured interview thematic analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170104580 PUI L614347375 DOI 10.1002/pon.4346 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4346 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 24 TITLE Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting AUTHOR NAMES DiPiro P.J. Krajewski K.M. Giardino A.A. Braschi-Amirfarzan M. Ramaiya N.H. AUTHOR ADDRESSES (DiPiro P.J., pdipiro@partners.org; Krajewski K.M.; Giardino A.A.; Braschi-Amirfarzan M.; Ramaiya N.H.) Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, United States. (DiPiro P.J., pdipiro@partners.org; Krajewski K.M.; Giardino A.A.; Braschi-Amirfarzan M.; Ramaiya N.H.) Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States. CORRESPONDENCE ADDRESS P.J. DiPiro, Department of Radiology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, United States. Email: pdipiro@partners.org SOURCE Korean Journal of Radiology (2017) 18:1 (18-27). Date of Publication: 1 Jan 2017 ISSN 1229-6929 BOOK PUBLISHER Korean Radiological Society, office@radiology.or.kr ABSTRACT The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consultation health service oncology radiology tertiary care center EMTREE MEDICAL INDEX TERMS awareness breast cancer decision making gastrointestinal hemorrhage general practitioner human intervention study mastectomy neuroradiology oncology ward partial mastectomy patient care radiologist review symptomatology EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170056914 PUI L614127245 DOI 10.3348/kjr.2017.18.1.18 FULL TEXT LINK http://dx.doi.org/10.3348/kjr.2017.18.1.18 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 25 TITLE Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis AUTHOR NAMES Wong S.M. Stout N.K. Punglia R.S. Prakash I. Sagara Y. Golshan M. AUTHOR ADDRESSES (Wong S.M.) Harvard School of Public HealthBoston Massachusetts (Wong S.M.; Prakash I.) Department of SurgeryMcGill University Health CenterMontreal, Quebec Canada (Stout N.K.) Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBoston, Massachusetts (Punglia R.S.) Department of Radiation Oncology Brighamand Women's Hospital/Dana-Farber Cancer Institute Harvard Medical SchoolBoston, Massachusetts (Sagara Y.) Department of Breast OncologySagara Hospital, Hakuaikai Medical CorporationKagoshima Japan (Sagara Y.; Golshan M., mgolshan@partners.org) Department of SurgeryBrigham and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical SchoolBoston, Massachusetts CORRESPONDENCE ADDRESS M. Golshan, Department of Surgery, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA 02115 Email: mgolshan@partners.org SOURCE Cancer (2017). Date of Publication: 2017 ISSN 1097-0142 (electronic) 0008-543X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND: Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS. METHODS: A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies. Probabilities for invasive breast cancer, breast cancer-specific mortality, other-cause mortality and the effectiveness of preventive strategies were derived from published studies and from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. RESULTS: Assuming a breast cancer incidence from 1.02% to 1.37% per year under active surveillance, a woman aged 50 years diagnosed with LCIS would have a total LE of 32.78 years and would gain 0.13 years (1.6 months) in LE by adding chemoprevention and 0.25 years (3.0 months) in LE by adding bilateral prophylactic mastectomy. After quality adjustment, chemoprevention resulted in the greatest QALE for women ages 40 to 60 years at LCIS diagnosis, whereas surveillance remained the preferred strategy for optimizing QALE among women diagnosed at age 65 years and older. CONCLUSIONS: In this model, among women with a diagnosis of LCIS, breast cancer prevention strategies only modestly affected overall survival, whereas chemoprevention was modeled as the preferred management strategy for optimizing invasive disease-free survival while prolonging QALE form women younger than 65 years. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma cancer prevention prognosis EMTREE MEDICAL INDEX TERMS adult aged breast cancer cancer incidence cancer mortality carcinoma in situ chemoprophylaxis clinical study data base diagnosis disease free survival female human life expectancy middle aged national health organization overall survival probability prophylactic mastectomy risk reduction simulation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170144760 PUI L614542946 DOI 10.1002/cncr.30644 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.30644 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 26 TITLE Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy AUTHOR NAMES Manne S.L. Topham N. D'Agostino T.A. Myers Virtue S. Kirstein L. Brill K. Manning C. Grana G. Schwartz M.D. Ohman-Strickland P. AUTHOR ADDRESSES (Manne S.L., Sharon.Manne@rutgers.edu; D'Agostino T.A.; Myers Virtue S.; Kirstein L.; Ohman-Strickland P.) Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, United States. (Topham N.) Department of Surgery, Fox Chase Cancer Center, Philadelphia, United States. (Brill K.; Grana G.) MD Anderson Cancer Center at Cooper Health Systems, Camden, United States. (Manning C.) Triad Interactive, Inc, Washington, United States. (Schwartz M.D.) Lombardi Cancer Center, Washington, United States. CORRESPONDENCE ADDRESS S.L. Manne, Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, United States. Email: Sharon.Manne@rutgers.edu SOURCE Psycho-Oncology (2016) 25:12 (1424-1433). Date of Publication: 1 Dec 2016 ISSN 1099-1611 (electronic) 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Objective: The study aim was to test the acceptability and preliminary efficacy of a novel interactive web-based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy. Methods: Fifty-five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later. Results: In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow-up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow-up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions. Conclusion: A widely available free pamphlet and a web-based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web-based decision support aid. Copyright © 2015 John Wiley & Sons, Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction clinical decision support system clinical effectiveness Internet mastectomy program acceptability web based breast reconstruction decision support aid EMTREE MEDICAL INDEX TERMS adult aged anxiety article cancer diagnosis cancer patient clinical decision making community program conflict controlled study female follow up health survey human knowledge major clinical study medical literature pilot study randomized controlled trial treatment duration EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015390692 PUI L606090874 DOI 10.1002/pon.3984 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3984 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 27 TITLE Treatment decision-making in ductal carcinoma in situ: A mixed methods systematic review of women's experiences and information needs AUTHOR NAMES Rutherford C. Mercieca-Bebber R. Butow P. Wu J.L. King M.T. AUTHOR ADDRESSES (Rutherford C., claudia.rutherford@sydney.edu.au; Mercieca-Bebber R.; Butow P.; Wu J.L.; King M.T.) School of Psychology, University of Sydney, NSW, 2006, Australia (Rutherford C., claudia.rutherford@sydney.edu.au; Mercieca-Bebber R.; Butow P.; King M.T.) Psycho-Oncology Co-operative Group (PoCoG), University of Sydney, NSW, 2006, Australia (Mercieca-Bebber R.; King M.T.) Central Clinical School, Sydney Medical School, University of Sydney, NSW, 2006, Australia CORRESPONDENCE ADDRESS C. Rutherford, Quality of Life Office, Psycho-Oncology Co-operative Research Group, University of Sydney, Level 6 North, Chris O'Brien Lifehouse C39Z, NSW, 2006, Australia Email: claudia.rutherford@sydney.edu.au SOURCE Patient Education and Counseling (2017). Date of Publication: 30 Nov 2016 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objective: Decision-making in ductal carcinoma in situ (DCIS) is complex due to the heterogeneity of the disease. This study aimed to understand women's experience of making treatment decisions for DCIS, their information and support needs, and factors that influenced decisions. Methods: We searched six electronic databases, conference proceedings, and key authors. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Thematic analysis was used to combine and summarise findings. Results: We identified six themes and 28 subthemes from 18 studies. Women with DCIS have knowledge deficits about DCIS, experience anxiety related to information given at diagnosis and the complexity of decision-making, and have misconceptions regarding risks and outcomes of treatment. Women's decisions are influenced by their understanding of risk, the clinical features of their DCIS, and the benefits and harms of treatment options. Women are dissatisfied with the decisional support available. Conclusions: Informed and shared decision-making in this complex decision setting requires clear communication of information specific to DCIS and individual's, as well as decision support for patients and clinicians. Practice implications: This approach would educate patients and clinicians, and assist clinicians in supporting patients to an evidence-based treatment plan that aligns with individual values and pReferences. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intraductal carcinoma shared decision making EMTREE MEDICAL INDEX TERMS anxiety clinical feature data base decision support system diagnosis doctor patient relation evidence based practice center female human systematic review thematic analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170296001 PUI L615634423 DOI 10.1016/j.pec.2017.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2017.04.009 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 28 TITLE Development of a patient decision aid for women with early-stage breast cancer considering contralateral prophylactic mastectomy AUTHOR NAMES Ager B. AUTHOR ADDRESSES (Ager B.) University of Sydney, University Of Sydney, Australia. CORRESPONDENCE ADDRESS B. Ager, University of Sydney, University Of Sydney, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2016) 12 Supplement 5 (101-102). Date of Publication: 1 Nov 2016 CONFERENCE NAME 43rd Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA 2016 CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2016-11-15 to 2016-11-17 ISSN 1743-7563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Aims: The surgical removal of the unaffected breast in women with earlystage breast cancer (contralateral prophylactic mastectomy; CPM) has increased dramatically in recent years. Although CPM reduces risk of developing a second primary cancer (contralateral breast cancer) by 95%, CPM has not been associated with increased survival in this subset of women. We developed a decision aid for women with early-stage unilateral breast cancer considering CPM. This study aims to elicit feedback from women about the decision aid as part of the development process, in order to form the basis for a future randomized controlled trial. Methods: The content of the decision aid was based on the International Patient Decision Aids Standards (IPDAS), results from a previous patientpreference study and a systematic review on patient-reported reasons for CPM. The development process involved an expert advisory group of medical oncologists, breast cancer surgeons, psycho-oncologists and researchers with expertise in medical decision-making. In order to obtain consumer feedback, we plan to recruit 20 women diagnosed with stage I or II unilateral breast cancer between 40 and 75 years who have finished active breast cancer treatment. Eligible women may or may not have had CPM. Women will be recruited through a breast cancer research network. Consenting participants will be asked to attend an interview in person or over the phone to review the decision aid. The “think aloud” method will be used to assess patients' thoughts on the decision aid. Interviews will be recorded, transcribed and coded to highlight main areas of feedback. Results: The decision aid was finalized in June, 2016. We plan to present consumer feedback at COSA. Conclusion: Limited information resources are currently available for women considering CPM. This project includes a novel decision aid to assist women in making this difficult decision. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer prophylactic mastectomy EMTREE MEDICAL INDEX TERMS cancer research cancer therapy clinical article clinical trial consumer controlled study diagnosis disease course DNA transcription female human interview medical decision making medical oncologist scientist surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613440271 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 29 TITLE Attitudes and Decisional Conflict Regarding Breast Reconstruction among Breast Cancer Patients AUTHOR NAMES Manne S.L. Topham N. Kirstein L. Virtue S.M. Brill K. Devine K.A. Gajda T. Frederick S. Darabos K. Sorice K. AUTHOR ADDRESSES (Manne S.L., sharon.manne@rutgers.edu; Kirstein L.; Virtue S.M.; Devine K.A.; Gajda T.; Frederick S.; Darabos K.) Department of Medicine, Robert Wood Johnson Medical School, Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, United States. (Topham N.) Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, United States. (Brill K.) Anderson Cancer Center at Cooper Health Systems, Voorhees Township, New Jersey, United States. (Sorice K.) Department of Surgery, Fox Chase Cancer Center, Philadelphia, United States. CORRESPONDENCE ADDRESS S.L. Manne, Department of Medicine, Robert Wood Johnson Medical School, Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, United States. Email: sharon.manne@rutgers.edu SOURCE Cancer Nursing (2016) 36:6 (427-436). Date of Publication: 1 Nov 2016 ISSN 1538-9804 (electronic) 0162-220X BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Background: The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision. Objective: Using the Ottawa Decision Support Framework, this study aims to describe women's reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. Methods: Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR. Results: The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. Conclusions: The results suggest that breast cancer patients considering BR may benefit from decisional support. Implications for Clinical Practice: Healthcare professionals may facilitate decision making by focusing on reasons for each patient's uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction EMTREE MEDICAL INDEX TERMS adult article attitude cancer patient conflict controlled study decision making decision support system early cancer (surgery) female health care personnel human intraductal carcinoma (surgery) knowledge lumpectomy major clinical study mastectomy pilot study plastic surgeon postoperative complication (complication) postoperative pain (complication) priority journal randomized controlled trial scar formation (complication) surgical risk EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160060251 PUI L607842253 DOI 10.1097/NCC.0000000000000320 FULL TEXT LINK http://dx.doi.org/10.1097/NCC.0000000000000320 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 30 TITLE Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer AUTHOR NAMES Balneaves L.G. Panagiotoglou D. Brazier A.S.A. Lambert L.K. Porcino A. Forbes M. Van Patten C. Truant T.L.O. Seely D. Stacey D. AUTHOR ADDRESSES (Balneaves L.G., lynda.balneaves@utoronto.ca) Centre for Integrative Medicine, Leslie Dan Faculty of Pharmacy, 144 College St., Room 737, Toronto, Canada. (Balneaves L.G., lynda.balneaves@utoronto.ca) Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada. (Panagiotoglou D.; Brazier A.S.A.; Lambert L.K.; Truant T.L.O.) School of Nursing, University of British Columbia, Vancouver, Canada. (Porcino A.) Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (Forbes M.) Juravinski Cancer Centre, Hamilton, Canada. (Van Patten C.) British Columbia Cancer Agency, Vancouver, Canada. (Seely D.) Ottawa Integrative Cancer Centre, Ottawa, Canada. (Stacey D.) School of Nursing, University of Ottawa, Ottawa, Canada. CORRESPONDENCE ADDRESS L.G. Balneaves, Centre for Integrative Medicine, Leslie Dan Faculty of Pharmacy, 144 College St., Room 737, Toronto, Canada. Email: lynda.balneaves@utoronto.ca SOURCE Supportive Care in Cancer (2016) 24:11 (4567-4575). Date of Publication: 1 Nov 2016 ISSN 1433-7339 (electronic) 0941-4355 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Purpose: For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors’ CT and general information and decision-making needs related to menopausal symptoms. Methods: The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data. Results: Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management. Conclusions: High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment. EMTREE DRUG INDEX TERMS alpha tocopherol (drug therapy) antidepressant agent (drug therapy) gabapentin (drug therapy) hormone (drug therapy) natural product (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system medical information menopausal syndrome (drug therapy, drug therapy, therapy) needs assessment EMTREE MEDICAL INDEX TERMS access to information Actaea racemosa acupuncture adult alternative medicine article cancer center cancer survivor Caucasian Chinese medicine clinical article controlled study diet therapy environmental change female flower Ganoderma lucidum health care personnel homeopathy hormone substitution human information processing information seeking interview lifestyle linseed menstrual cycle middle aged passion flower prescription priority journal shared decision making soy therapy effect time vaginal moisturizer CAS REGISTRY NUMBERS alpha tocopherol (1406-18-4, 1406-70-8, 52225-20-4, 58-95-7, 59-02-9) gabapentin (60142-96-3) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160480362 PUI L610985996 DOI 10.1007/s00520-016-3296-x FULL TEXT LINK http://dx.doi.org/10.1007/s00520-016-3296-x COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 31 TITLE Review of multicriteria decision analysis application for decision-making in oncology AUTHOR NAMES Dombrovskiy V.S. Omelyanovskiy V. AUTHOR ADDRESSES (Dombrovskiy V.S.) Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation. (Omelyanovskiy V.) Center for Health Technology Assessment, Russian Presidential Academy of National Economy and Public Administration, Center of Comprehensive Health Technology Assessment, Ministry of Health of the Russian Federation, Moscow, Russian Federation. CORRESPONDENCE ADDRESS V.S. Dombrovskiy, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation. SOURCE Value in Health (2016) 19:7 (A751). Date of Publication: 1 Nov 2016 CONFERENCE NAME ISPOR 19th Annual European Congress CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2016-10-29 to 2016-11-02 ISSN 1524-4733 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: The spectrum of cancer treatment is very wide and increases every year. There is not enough certainty in oncology about decision-making process and factors that may be associated with observed variation in cancer treatment and patient outcomes. Nonetheless, there exist a logical, structured, and transparent approach that can increase transparency of the decision-making process and is referred to as multicriteria decision analysis (MCDA). Objectives: to identify application experience of MCDA in the context of oncology by reviewing published literature. Methods: The search was conducted in PubMed and the Cochrane Library in January 2016. Studies of any design that used MCDA within the context of oncology published in English were considered. Databases were searched using the free text terms: 'multi-criteria decision analysis', 'multicriteria decision analysis', 'multiple criteria decision aiding', 'multi-criteria decision making', 'multicriteria analysis'. The above free text terms were combined with 'oncology' and 'cancer' using Boolean operators when necessary. Results: Fourteen publications were included. Eight studies focused on decision-making in regard to cancer diagnosis. Four of them have demonstrated the applicability of the Analytic Hierarchy Process (AHP) method in the field of patient decision-making. In three studies MCDA was implemented in the clinical decision support systems. Other three studies applied MCDA in quantitative benefit-risk assessment of the quadrivalent HPV vaccine; to develop a decision support tool in order to assist pharmacists choosing the anticancer drugs that can be produced in advance; and to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries. Conclusions: Possibility of carrying out of such an analysis as the AHP by one person, represents significant opportunities for its development in patient decision-making process in regard to cancer diagnosis. MCDA is not routinely used in oncology and most studies focus on the clinicians and patients side instead policymakers. EMTREE DRUG INDEX TERMS antineoplastic agent Wart virus vaccine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) oncology patient decision making EMTREE MEDICAL INDEX TERMS breast cancer cancer diagnosis clinical decision support system Cochrane Library disease carrier doctor patient relation female human Medline middle income country pharmacist publication quantitative study risk assessment systematic review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613235815 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 32 TITLE Toward the development of a patient decision aid for women with ductal carcinoma in situ of the breast AUTHOR NAMES Rutherford C. Spillane A. Boxer M. McPherson J. Winters Z. Mercieca-Bebber R. Tait M.-A. King M. AUTHOR ADDRESSES (Rutherford C.; Spillane A.; Boxer M.; McPherson J.; Winters Z.; Mercieca-Bebber R.; Tait M.-A.; King M.) CORRESPONDENCE ADDRESS C. Rutherford, SOURCE Asia-Pacific Journal of Clinical Oncology (2016) 12 Supplement 5 (101). Date of Publication: 1 Nov 2016 CONFERENCE NAME 43rd Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA 2016 CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2016-11-15 to 2016-11-17 ISSN 1743-7563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Aims Ductal carcinoma in situ (DCIS) is a precursor to invasive breast cancer. Treatment aims to eliminate progression to invasive disease. Ten-year survival is excellent across treatments, therefore patient values and preferences are important considerations in shared decision-making (SDM). A decision aid (DA) could facilitate SDM. We document the background processes involved in development of aDA that meets users' needs and is likely to be implemented into practice. Methods To develop a DA, we undertook:(i) a systematic literature review to identify clinical practice guidelines (CPGs) for management of DCIS and clinical and patient-reported outcome (PRO) evidence and (ii) qualitative research to determine the information needs of women with DCIS and treating clinicians, how they prefer this information to be presented and clinicians' attitudes toward and barriers to using a DA. ResultsWe found variation between CPG recommendations (n=31) for management of DCIS, and that PRO evidence rarely informs treatment decisionmaking. Information regarding survival, recurrence/invasive disease rates, morbidity and side effects of available treatments was collated; however, evidence about PROs is limited and short-/long-term PRO differences between treatments are lacking. Women with DCIS (n = 24) want up-to-date and individualized DCIS-specific information, to be: informed about all treatment options, prepared for likely and possible side effects of treatment (e.g. quality of life, pain, fatigue and body image) and involved in SDM. Clinicians (n = 30) identified a need for DCIS-specific information and the important role of breast care nurses (BCNs) in providing information and facilitating SDM, but acknowledged that BCNs often lack adequate training in SDM or meet patients after decisions are made. Clinicians support patient involvement in decision-making and a web-based interactive DA to facilitate SDM. Conclusions A DCIS DA must meet the information needs of DCIS patients and their managing clinicians, contain up-to-date evidence and incorporate patient values and preferences in decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intraductal carcinoma EMTREE MEDICAL INDEX TERMS body image breast care chronic patient consensus development doctor patient relation fatigue female human morbidity nurse pain patient participation patient-reported outcome practice guideline qualitative research quality of life relapse shared decision making side effect survival systematic review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613440267 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 33 TITLE Decision aids, patient views and barriers AUTHOR NAMES Zdenkowski N. AUTHOR ADDRESSES (Zdenkowski N.) Calvary Mater Newcastle, Waratah, Australia. CORRESPONDENCE ADDRESS N. Zdenkowski, Calvary Mater Newcastle, Waratah, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2016) 12 Supplement 5 (84-85). Date of Publication: 1 Nov 2016 CONFERENCE NAME 43rd Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA 2016 CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2016-11-15 to 2016-11-17 ISSN 1743-7563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Neoadjuvant systemic therapy (NAST), including chemotherapy and endocrine therapy, continues to gain acceptance as a treatment option for selected women with large and/or highly proliferative, operable breast cancer. While recurrence and survival outcomes are equivalent in patients treated with adjuvant compared with NAST, some women may prefer one treatment sequence over the other. This adds complexity at a time when women may be distressed by a recent diagnosis of breast cancer and are already facing decisions about multidisciplinary treatment options. Women (n = 22) with a recent diagnosis of operable invasive breast cancer were interviewed, focusing on decisions about NAST. Women who were offered NAST (n = 19) felt unable to participate in decision-making as fully as they would have liked, due to a lack of patient information, the complexity of the decision and a sense of clinical urgency. Despite this, all participants endorsed NAST as a treatment option for tumor downstaging, to give time for consideration of other treatment options, for prognostic purposes and so that chemotherapy could be administered promptly. Breast oncology clinicians from Australia and New Zealand (n = 207) responded to an online survey on their views and practice with NAST. Seventyeight percent reported routinely offering NAST to selected patients with operable breast cancer; however, 45% and 58% wanted to increase the number in routine care and clinical trials, respectively. Clinician-, patient- and systemrelated barriers prevented optimal use of NAST. Awareness and lack of information were key concerns. To address the decisional complexity, lack of awareness and lack of information, a decision aid was developed for women with operable breast cancer who are considering NAST. The decision aid was based on patient and clinician perspectives, literature review, international patient decision aid standards and expert consultation. This decision aid is being tested in an ongoing prospective single arm longitudinal study. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) AIDS patient EMTREE MEDICAL INDEX TERMS Australia and New Zealand awareness breast cancer chemotherapy clinical trial consultation controlled study decision making diagnosis doctor patient relation drug therapy female hormonal therapy human longitudinal study major clinical study oncology patient information relapse survival systemic therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613440242 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 34 TITLE A multi-centred study of the effectiveness of PEGASUS, an intervention to promote shared decision making about breast reconstruction AUTHOR NAMES Harcourt D. Paraskeva N. White P. Powell J. Clarke A. AUTHOR ADDRESSES (Harcourt D.; Paraskeva N.; White P.; Powell J.; Clarke A.) University of the West of England, Bristol, United Kingdom. CORRESPONDENCE ADDRESS N. Paraskeva, University of the West of England, Bristol, United Kingdom. SOURCE Psycho-Oncology (2016) 25 Supplement 3 (144-145). Date of Publication: 1 Oct 2016 CONFERENCE NAME 2016 World Congress of Psycho-Oncology CONFERENCE LOCATION Dublin, Ireland CONFERENCE DATE 2016-10-17 to 2016-10-21 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Background/Purpose: Decision making about breast reconstruction after mastectomy can be difficult. Women's expectations of the surgery are often not met, and dissatisfaction with outcome and ongoing psychosocial distress are common. PEGASUS (Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) supports shared decision making by helping women clarify their individual goals about reconstruction, stratifying these as physical (e.g., breast shape) versus psychological (e.g., improve self confidence) and ranking their importance, then using them to guide discussion of expectations with their surgical team. Acceptability/feasibility work has shown it is well received by patients and health professionals alike. This trial examines its efficacy alongside a health economic analysis. Methods: A mixed method, multi-centred time-sequential between subjects before-and-after design comparing usual care (n = 90) with the intervention (PEGASUS) (n = 90). The usual care group will be recruited before health professionals are trained to use PEGASUS, which will then be delivered to the intervention group. Standardized measures (Breast-Q, EQ-5D-5L, Decisional Conflict Scale, Collabo- RATE, ICECAP-A) at the time of decision making, 3, 6 and 12 months after surgery. Interviews with health professionals and a purposefully selected sample of participants will explore whether expectations of reconstruction were met, and their experiences of PEGASUS (if appropriate). Results: Statistical analysis will examine changes in self-report scores over time and compare the intervention and usual care groups. Conclusions: PEGASUS has the potential to provide health professionals with a tool to support shared decision making, identify expectations and improve breast cancer patients' satisfaction with breast reconstruction. Results will be available in 2019. EMTREE DRUG INDEX TERMS endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction shared decision making EMTREE MEDICAL INDEX TERMS breast cancer cancer patient expectation feasibility study female human human tissue interview major clinical study satisfaction self report statistical analysis surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612930813 DOI 10.1002/pon.4272 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4272 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 35 TITLE Breast Conservation Therapy Versus Mastectomy: Shared Decision-Making Strategies and Overcoming Decisional Conflicts in Your Patients AUTHOR NAMES Margenthaler J.A. Ollila D.W. AUTHOR ADDRESSES (Margenthaler J.A., margenthalerj@wudosis.wustl.edu) Department of Surgery, Washington University School of Medicine, St. Louis, United States. (Ollila D.W.) Department of Surgery, University of North Carolina, Chapel Hill, United States. CORRESPONDENCE ADDRESS J.A. Margenthaler, Department of Surgery, Washington University School of Medicine, St. Louis, United States. Email: margenthalerj@wudosis.wustl.edu SOURCE Annals of Surgical Oncology (2016) 23:10 (3133-3137). Date of Publication: 1 Oct 2016 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Although breast-conserving therapy is considered the preferred treatment for the majority of women with early-stage breast cancer, mastectomy rates in this group remain high. The patient, physician, and systems factors contributing to a decision for mastectomy are complicated. Understanding the individual patient’s values and goals when making this decision is paramount to providing a shared decision-making process that will yield the desired outcome. The cornerstones of this discussion include education of the patient, access to decision-aid tools, and time to make an informed decision. However, it is also paramount for the physician to understand that a significant majority of women with an informed and complete understanding of their surgical choices will still prefer mastectomy. The rates of breast conservation versus mastectomy should not be considered a quality measure alone. Rather, the extent by which patients are informed, involved in decision-making, and undergoing treatments that reflect their goals is the true test of quality. Here we explore some of the factors that impact the patient preference for breast conservation versus mastectomy and how shared decision-making can be maximized for patient satisfaction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consensus development decision making mastectomy EMTREE MEDICAL INDEX TERMS controlled study doctor patient relation education female human human experiment patient preference patient satisfaction surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160570923 PUI L611522018 DOI 10.1245/s10434-016-5369-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-016-5369-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 36 TITLE Impact of a web-based decision aid for women considering breast reconstruction: Study protocol for a multicenter randomized controlled trial AUTHOR NAMES Stege J.T. Woerdeman L. Hahn D. Oldenburg H. Van Huizum M. Witkamp A. Van Duijnhoven F. Sherman K. Bleiker E. AUTHOR ADDRESSES (Stege J.T.; Bleiker E.) Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands. (Woerdeman L.; Van Huizum M.) Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands. (Hahn D.) Department of Psychosocial Counseling, Netherlands Cancer Institute, Amsterdam, Netherlands. (Oldenburg H.; Van Duijnhoven F.) Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands. (Witkamp A.) Department of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, Netherlands. (Sherman K.) Department of Psychology, Macquarie University, Sydney, Australia. (Sherman K.) Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. CORRESPONDENCE ADDRESS J.T. Stege, Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands. SOURCE Psycho-Oncology (2016) 25 Supplement 3 (102). Date of Publication: 1 Oct 2016 CONFERENCE NAME 2016 World Congress of Psycho-Oncology CONFERENCE LOCATION Dublin, Ireland CONFERENCE DATE 2016-10-17 to 2016-10-21 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Background: Decisions about breast reconstruction depend to a great extent on personal preferences of the patient and can be difficult to make. Additionally, a substantial number of women experience mild to strong levels of post-decisional regret. To support decision-making in breast reconstruction, a Dutch web-based decision aid is currently being developed. Our aim is to investigate the impact of the intervention on facilitating decision-making. Methods: A multicenter randomized controlled trial will be conducted. In total, 400 women eligible for breast reconstruction due to (an increased risk of) breast cancer will be invited to participate. The web-based decision aid will be offered to the intervention group. The control group will receive care as usual accompanied by a standard information leaflet on breast reconstruction. Both groups will be requested to complete questionnaires at baseline and 1, 6, and 12 months follow-up. Primary outcomes are decisional conflict, postdecisional regret, satisfaction with information and knowledge of breast reconstruction. Other patient reported outcomes such as health-related quality of life will be compared between groups as secondary outcomes. Furthermore, implementation measures among both patients in the intervention group and healthcare professionals will be evaluated. Results: First results are expected in 2017. Discussion: This study will provide empirical evidence regarding the efficacy of a web-based decision aid that is currently being developed in terms of facilitating women in their decision-making about breast reconstruction. Moreover, results will give insight into factors related to successful implementation of the intervention into a breast cancer care setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS breast cancer clinical trial control group controlled clinical trial controlled study decision making female follow up human major clinical study patient-reported outcome quality of life questionnaire randomized controlled trial satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612930801 DOI 10.1002/pon.4272 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4272 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 37 TITLE Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice AUTHOR NAMES Schapira M.M. Sprague B.L. Klabunde C.N. Tosteson A.N.A. Bitton A. Chen J.S. Beaber E.F. Onega T. MacLean C.D. Harris K. Howe K. Pearson L. Feldman S. Brawarsky P. Haas J.S. on behalf of the PROSPR consortium AUTHOR ADDRESSES (Schapira M.M., mschap@upenn.edu) University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, United States. (Sprague B.L.; MacLean C.D.; Howe K.) University of Vermont, Burlington, United States. (Klabunde C.N.) Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, United States. (Tosteson A.N.A.; Onega T.; Pearson L.) Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, United States. (Bitton A.; Feldman S.) Harvard Medical School, Boston, United States. (Bitton A.; Chen J.S.; Harris K.; Feldman S.; Brawarsky P.) Brigham and Women’s Hospital, Boston, United States. (Beaber E.F.) Fred Hutchinson Cancer Research Center, Seattle, United States. (Haas J.S.) Division of General Internal Medicine and Primary Care, Brigham and Woman’s Hospital, Boston, United States. (on behalf of the PROSPR consortium) CORRESPONDENCE ADDRESS M.M. Schapira, University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, United States. Email: mschap@upenn.edu SOURCE Journal of General Internal Medicine (2016) 31:10 (1148-1155). Date of Publication: 1 Oct 2016 ISSN 1525-1497 (electronic) 0884-8734 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. Objective: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH). Design: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. Participants: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. Main Measures: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. Key Results: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58–6.61) or cervical (OR 2.56, 95 % CI 1.32–4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15–41.7) or cervical (OR. 2.56, 95 % CI 1.26–5.26) cancer screening. Conclusions: Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer screening health care system primary medical care uterine cervix cancer EMTREE MEDICAL INDEX TERMS adult article cancer risk clinical assessment clinical decision support system clinical evaluation clinical practice controlled study electronic health record female follow up general practitioner human male middle aged multicenter study normal human nurse practitioner outcome assessment patient care physician assistant prevalence protocol compliance risk assessment EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160426640 PUI L610650749 DOI 10.1007/s11606-016-3726-y FULL TEXT LINK http://dx.doi.org/10.1007/s11606-016-3726-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 38 TITLE The role of psycho-oncology in cancer prevention AUTHOR NAMES Fielding R. Butow P. Janda M. Stein K. Rosberger Z. AUTHOR ADDRESSES (Fielding R.) University of Hong Kong, Hong Kong, Hong Kong. (Butow P.) School of Psychology, University of Sydney, Sydney, Australia. (Janda M.) School of Public Health and Social Work, University of Sydney, Australia. (Stein K.) Division Behavioural Research, American Cancer Society, Atlanta, United States. (Rosberger Z.) Department of Psychology, McGill University, Montreal, Canada. CORRESPONDENCE ADDRESS R. Fielding, University of Hong Kong, Hong Kong, Hong Kong. SOURCE Psycho-Oncology (2016) 25 Supplement 3 (14-16). Date of Publication: 1 Oct 2016 CONFERENCE NAME 2016 World Congress of Psycho-Oncology CONFERENCE LOCATION Dublin, Ireland CONFERENCE DATE 2016-10-17 to 2016-10-21 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT New improved genetic and classical diagnostic methods and treatments lead to diminished, boundaries between cancer risk factors, diagnosis, and prevention of first and subsequent cancers. In 2015, the publication “The missing piece: cancer prevention within psychooncology” raised awareness about prevention issues in the psychooncology community. Topics debated include whether psycho-oncologists should: mainly aim to prevent psychological problems or also lifestyle improvements; collaborate with public health specialists; focus on the most common preventable cancers only; further revise the expanded model given latest advances in genetic research; lobby for larger systems changes to keep people healthy rather than treat the sick; lobby for remuneration models for preventive services. In this symposium, Zeev Rosberger will give an “update on the expanded model of cancer prevention research in psycho-oncology since the 2015 publication”. Presentations will elaborate on practical applications: Richard Fielding “Evidence and need for residual symptoms prevention”; Kevin Stein “Application of health behavior change theory in health promotion and secondary cancer prevention in cancer survivors”; Phyllis Butow “Can psycho-oncology assist women who have to make difficult decisions including uptake of contralateral mastectomy and selective estrogen receptor modulators”; Monika Janda “Endometrial cancer patients lifestyle changes after cancer, and uptake of weight loss interventions depending on anxiety and depression”. The symposium shows that there is considerable activity by psychooncology clinicians and researchers in the field of cancer prevention. Further discussion is required to take advantage of the synergies between public health and psycho-oncology, and how to steer the preventive psycho-oncology agenda. Supporting Abstract 1: How do women decide about preventive treatments? Contralateral prophylactic mastectomy after early stage breast cancer & selective oestrogen receptor modulators in women at high risk Authors: Phyllis Butow1,2,3, Kelly Phillips3,4,5, David Porter3,6,7, Brittany Agar1 2, Angelique Ralph1,2, Stephanie Tessen 1,2, Imogen Richards1,2, Kathy Tucker8, Lesley Andrews8. 1. Psycho-Oncology Co-operative Research Group, U. Sydney 2. Psychology, U. Sydney 3. ANZ Breast Cancer Trials Group. 4. Div. Cancer Medicine, Peter MacCallum Centre 5. Dept. Medicine, St Vincent's Hospital, U Melbourne 6. Dept. Medical Oncology, Auckland Hospital, NZ 7. Medical and Health Sciences, U Auckland, NZ 8. Familial Cancer Clinic, Prince of Wales Hospital, Australia. Purpose: Women at high risk of breast cancer, or diagnosed with early stage breast cancer (BC), consider options to prevent future cancers or cancer relapse. Two separate studies investigated the utility of protection motivation theory and the theory of planned behaviour in explaining women's hypothetical decision-making. Methods: 107 women at increased risk of BC and 400 women previously treated for BC, completed a questionnaire exploring hypothetical intentions to take selective oestrogen receptor modulators (SERMS) or undergo contralateral prophylactic mastectomy (CPM), respectively. Demographic and disease variables, and theoretical constructs, were included as predictors. Results: Women who believed SERMS or CPM would effectively lower their risk, and would not have many downsides, perceived greater social pressure to have SERMS or CPM, anticipated regret (if they developed BC having rejected SERMS or CPM), tended to avoid uncertainty, felt they could cope with SERMS or CPM, and felt they were at greater risk of BC - were more likely to declare an hypothetical intention to undergo SERMS or CPM. Overall the models explained 16-44% of the variances in intention. Women self-reported that risk reduction and desire for breast symmetry (CPM only) motivated a positive decision, while desire to avoid side effects or post-operative risks, low perceived risk, choosing another method of risk reduction and avoiding financial costs motivated a negative decision. Conclusions: Women weigh up both positive and negative aspects of preventive therapy before making decisions. Clinicians should explore women's understanding and perceptions when assisting women to reach decisions. Supporting Abstract 2: How do women decide about preventive treatments? Contralateral prophylactic mastectomy after early stage breast cancer & selective oestrogen receptor modulators in women at high risk. Authors: Phyllis Butow1,2,3, Kelly Phillips3,4,5, David Porter3,6,7, Brittany Agar1 2, Angelique Ralph1,2, Stephanie Tessen 1,2, Imogen Richards1,2, Kathy Tucker8, Lesley Andrews8. 1. Psycho-Oncology Co-operative Research Group, U. Sydney 2. Psychology, U. Sydney 3. ANZ Breast Cancer Trials Group. 4. Div. Cancer Medicine, Peter MacCallum Centre 5. Dept. Medicine, St Vincent's Hospital, U Melbourne 6. Dept. Medical Oncology, Auckland Hospital, NZ 7. Medical and Health Sciences, U Auckland, NZ 8. Familial Cancer Clinic, Prince of Wales Hospital, Australia. Purpose: Women at high risk of breast cancer, or diagnosed with early stage breast cancer (BC), consider options to prevent future cancers or cancer relapse. Two separate studies investigated the utility of protection motivation theory and the theory of planned behaviour in explaining women's hypothetical decision-making. Methods: 107 women at increased risk of BC and 400 women previously treated for BC, completed a questionnaire exploring hypothetical intentions to take selective oestrogen receptor modulators (SERMS) or undergo contralateral prophylactic mastectomy (CPM), respectively. Demographic and disease variables, and theoretical constructs, were included as predictors. Results: Women who believed SERMS or CPM would effectively lower their risk, and would not have many downsides, perceived greater social pressure to have SERMS or CPM, anticipated regret (if they developed BC having rejected SERMS or CPM), tended to avoid uncertainty, felt they could cope with SERMS or CPM, and felt they were at greater risk of BC - were more likely to declare an hypothetical intention to undergo SERMS or CPM. Overall, the models explained 16- 44% of the variances in intention. Women self-reported that risk reduction and desire for breast symmetry (CPM only) motivated a positive decision, while desire to avoid side effects or post-operative risks, low perceived risk, choosing another method of risk reduction and avoiding financial costs motivated a negative decision. Conclusions: Women weigh up both positive and negative aspects of preventive therapy before making decisions. Clinicians should explore women's understanding and perceptions when assisting women to reach decisions. Endometrial cancer patients' lifestyle changes after cancer, and uptake of weight loss interventions depending on anxiety and depression Monika Janda, Institute for Health and Biomedical Innovation, School of Public Health and Social Work Queensland University of Technology, Brisbane Australia; m.janda@qut.edu.au Supporting Abstract 3: Background: Endometrial cancer is the most common gynaecological malignancy in women, often strongly associated with obesity and lack of physical activity. Little is known about women's interest in lifestyle interventions after treatment. Methods: The Teacup study enrolled 122 women 1-4 years after treatment. Participants completed self-administered questionnaires including the Hospital Anxiety and Depression Scale (8-points cut-off for likely anxiety or depression), and interest in counselling or lifestyle interventions. We used baseline survey data and Chi-Square χ(2) Tests compared women with high or low anxiety/depression. Results: At a median of 2-years post-surgery, patients were on average 65 years (39-87), 51% living with a partner, 52% retired. Overall, 25% of women reported elevated anxiety, and 8% elevated depression levels. While women did not differ by anxiety or depression status in their interest in weight loss (43%), eating more healthily (47%), or physical activity (36%), women with elevated anxiety (63%) were more likely to be interested to learn how to manage stress compared to women with low anxiety (32%; χ(2) = 5.7; p = 0.02). No woman with anxiety planned to return to work or study compared to 20% of other women (χ(2) = 4.4; p = 0.04). The preferred format of lifestyle information was by mail (56%), SMS (37%) or telephone (31%), few were interested in group discussions (15%). Conclusions: About 50% of the women were interested in lifestyle programs, and wanted to receive information by mail. Anxiety elevated the need for stress management programs, and diminished women's desire to return to work or study. Supporting Abstract 4: Translation, Dissemination, and Implementation of Prevention Programs for Cancer Survivors: What We Know and Where We Need to Go Kevin Stein, Ph.D. Vice President, Behavioural Research Centre, American Cancer Society Due to treatment toxicities, cancer survivors are increased risk for a number of health conditions (e.g. late effects) compared to age/gender matched peers in the general population. A large body of evidence has demonstrated that healthy lifestyle behaviours (diet and physical activity) cannot only ameliorate symptoms of some conditions, but may also play an integral role in the prevention of others, as well as improve overall physical and emotional health. As such, investigators have developed interventions aimed at improving cancer survivors' lifestyle behaviours. Such interventions have proven to be safe, effective, and acceptable to survivors. However, most interventions have been conducted in controlled clinical settings, with few having been implemented in community-based settings. EMTREE DRUG INDEX TERMS endogenous compound estrogen receptor selective estrogen receptor modulator EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer center cancer prevention EMTREE MEDICAL INDEX TERMS anxiety awareness behavioral research breast cancer bullock cancer epidemiology cancer patient cancer risk cancer survivor cancer susceptibility change theory chi square test clinical trial controlled study counseling decision making diagnosis diet doctor patient relation eating emotional stability endometrium cancer female gender genetics health promotion health science hereditary tumor Hospital Anxiety and Depression Scale human hypokinesia lifestyle modification major clinical study male metastasis motivation non profit organization nonhuman obesity oncologist perception physical activity population preventive health service prophylactic mastectomy psychological model public health publication Queensland questionnaire remuneration return to work risk reduction scientist side effect social problem social work stress management surgical patient surgical risk symptom telephone theoretical model Theory of Planned Behavior toxicity tumor model uncertainty university Wales weight reduction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612930961 DOI 10.1002/pon.4272 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4272 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 39 TITLE Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery AUTHOR NAMES Catanuto G. Pappalardo F. Rocco N. Leotta M. Ursino V. Chiodini P. Buggi F. Folli S. Catalano F. Nava M.B. AUTHOR ADDRESSES (Catanuto G., giuseppecatanuto@gmail.com; Ursino V.; Catalano F.) U.O. C. Senologia – Azienda Ospedaliera Cannizzaro, Via Messina 829, Catania, Italy. (Catanuto G., giuseppecatanuto@gmail.com; Nava M.B.) Scuola di Oncologia Chirurgica Ricostruttiva – Onlus, Milano, Italy. (Pappalardo F.; Leotta M.) Università degli Studi di Catania, Catania, Italy. (Rocco N.) Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli ‘Federico II’, Napoli, Italy. (Chiodini P.) Unità di Statistica Medica, Seconda Università di Napoli, Napoli, Italy. (Buggi F.; Folli S.) U.O.C. Senologia – Ospedale Morgagni-Pierantoni, Italy. CORRESPONDENCE ADDRESS G. Catanuto, U.O. C. Senologia – Azienda Ospedaliera Cannizzaro, Via Messina 829, Catania, Italy. Email: giuseppecatanuto@gmail.com SOURCE Breast (2016) 29 (74-81). Date of Publication: 1 Oct 2016 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. Methodology We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. Results The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). Conclusion The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery medical decision making patient decision making software EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) breast malformation (prevention) decision support system decision tree human human computer interaction major clinical study mastectomy morbidity operator priority journal surgeon surgical approach EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160559451 MEDLINE PMID 27476081 (http://www.ncbi.nlm.nih.gov/pubmed/27476081) PUI L611378159 DOI 10.1016/j.breast.2016.06.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2016.06.004 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 40 TITLE Outcomes of contralateral prophylactic mastectomy in relation to familial history: A decision analysis (BRCR-D-16-00033) AUTHOR NAMES Davies K.R. Brewster A.M. Bedrosian I. Parker P.A. Crosby M.A. Peterson S.K. Shen Y. Volk R.J. Cantor S.B. AUTHOR ADDRESSES (Davies K.R., krdavies@mdanderson.org; Volk R.J., bvolk@mdanderson.org; Cantor S.B., sbcantor@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Unit 1444, P.O. Box 301402, Houston, United States. (Brewster A.M., abrewster@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Prevention, Houston, United States. (Bedrosian I., ibedrosian@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Breast Surgical Oncology, Houston, United States. (Parker P.A., parkerp@mskcc.org) Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, United States. (Crosby M.A., macrosby@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, United States. (Peterson S.K., speterso@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, United States. (Shen Y., yshen@mdanderson.org) The University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, United States. CORRESPONDENCE ADDRESS S.B. Cantor, The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Unit 1444, P.O. Box 301402, Houston, United States. Email: sbcantor@mdanderson.org SOURCE Breast Cancer Research (2016) 18:1 Article Number: 93. Date of Publication: 20 Sep 2016 ISSN 1465-542X (electronic) 1465-5411 BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Background: Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer incorporating the degree of family history. Methods: We created a microsimulation model for women with first-degree, second-degree, and no family history treated for a stage I, II, or III estrogen receptor (ER)-positive or ER-negative breast cancer at the ages of 40, 50, 60, and 70. The model incorporated a 10-year posttreatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate quality-adjusted life expectancy for the clinical strategies CPM and no CPM. Results: CPM showed minimal improvement on quality-adjusted life expectancy among women age 50-60 with no or a unilateral first-degree or second-degree family history (decreasing from 0.31 to -0.06 quality-adjusted life-years (QALYs)) and was unfavorable for most subgroups of women age 70 with stage III breast cancer regardless of degree of family history (range -0.08 to -0.02 QALYs). Sensitivity analysis showed that the highest predicted benefit of CPM assuming 95 % risk reduction in CBC was 0.57 QALYs for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer. Conclusions: Women age 40 with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For most subgroups of women, CPM has a minimal to no effect on quality-adjusted life expectancy, irrespective of family history of breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) contralateral prophylactic mastectomy family history prophylactic mastectomy treatment outcome EMTREE MEDICAL INDEX TERMS adult age distribution aged article cancer mortality cancer risk cancer staging cancer survival clinical article comparative study contralateral breast cancer (disease management, surgery) controlled study disease free survival estrogen receptor negative breast cancer (disease management, surgery) estrogen receptor positive breast cancer (disease management, surgery) female first-degree relative human life expectancy middle aged onset age overall survival quality adjusted life year risk reduction second-degree relative simulation EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160683549 PUI L612225168 DOI 10.1186/s13058-016-0752-y FULL TEXT LINK http://dx.doi.org/10.1186/s13058-016-0752-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 41 TITLE What’s new in genetic testing for cancer susceptibility? AUTHOR NAMES Plichta J.K. Griffin M. Thakuria J. Hughes K.S. AUTHOR ADDRESSES (Plichta J.K.) Division of Surgical Oncology, Massachusetts General Hospital, Boston, United States. (Griffin M.; Hughes K.S.) Division of Surgical Oncology, Massachusetts General Hospital, Boston, United States. (Thakuria J.) Division of Medical Genetics, Massachusetts General Hospital, Boston, United States. (Thakuria J.) Veritas Genetics, Danvers, United States. (Thakuria J.; Hughes K.S.) Harvard Medical School, Boston, United States. (Hughes K.S.) Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, United States. (Hughes K.S.) Bermuda Cancer Genetics and Risk Assessment Clinic, Bermuda. SOURCE ONCOLOGY (United States) (2016) 30:9. Date of Publication: 15 Sep 2016 ISSN 0890-9091 BOOK PUBLISHER UBM Medica Healthcare Publications, oncsubs@masub.com EMTREE DRUG INDEX TERMS APC protein (endogenous compound) ATR protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer susceptibility genetic screening EMTREE MEDICAL INDEX TERMS BRCA gene breast cancer (diagnosis) cancer screening decision support system DNA sequence gastrectomy gene gene identification gene mutation genetic recombination genetic variability human mastectomy nuclear magnetic resonance imaging ovary cancer (diagnosis) patient counseling practice guideline randomized controlled trial (topic) review EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160749632 MEDLINE PMID 27633409 (http://www.ncbi.nlm.nih.gov/pubmed/27633409) PUI L612616587 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 42 TITLE Predicting which patients actually receive radiation following breast conserving therapy in Canadian populations AUTHOR NAMES Guidolin K. Lock M. Richard L. Boldt G. Brackstone M. AUTHOR ADDRESSES (Guidolin K.; Lock M.; Richard L.; Boldt G.; Brackstone M.) From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone) SOURCE Canadian journal of surgery. Journal canadien de chirurgie (2016) 59:5 (358-360). Date of Publication: 1 Sep 2016 ISSN 1488-2310 (electronic) ABSTRACT SUMMARY: Canadian women with breast cancer may choose breast conserving therapy as their course of treatment, requiring both breast conserving surgery and adjuvant radiation therapy. However, more than 15% of Canadian women fail to receive the appropriate radiation therapy, putting them at increased risk for recurrence. Age, distance from their radiation therapy centre and stage of disease affect patients' likelihood of receiving prescribed radiation therapy. We propose a nomogram that allows physicians to predict which patients will and will not receive radiation. This nomogram, once validated, could be used to guide decision making when choosing between breast conserving therapy and mastectomy as the treatment course and thereby change the practice of breast cancer management. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system procedures standards EMTREE MEDICAL INDEX TERMS breast tumor (radiotherapy, surgery) clinical decision making female human mastectomy partial mastectomy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27438052 (http://www.ncbi.nlm.nih.gov/pubmed/27438052) PUI L615079827 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 43 TITLE Multidisciplinary team in the treatment of breast cancer-The role of preoperative meetings AUTHOR NAMES Szynglarewicz B. Maciejczyk A. Kasprzak P. Michalik T. Oleszkiewicz B. Borowiec T. Dupla D. Pawlaczyk A. Ochman M. Zebracka A. Djabelek-Macias M. Wisniewska I. Strychalska M. Matkowski R. AUTHOR ADDRESSES (Szynglarewicz B.; Maciejczyk A.; Kasprzak P.; Michalik T.; Oleszkiewicz B.; Borowiec T.; Dupla D.; Pawlaczyk A.; Ochman M.; Zebracka A.; Djabelek-Macias M.; Wisniewska I.; Strychalska M.; Matkowski R.) Lower Silesia Oncology Centre - Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland. CORRESPONDENCE ADDRESS B. Szynglarewicz, Lower Silesia Oncology Centre - Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland. SOURCE European Journal of Surgical Oncology (2016) 42:9 (S175-S176). Date of Publication: 1 Sep 2016 CONFERENCE NAME 36th Congress of the European Society of Surgical Oncology in Partnership with the Polish Society of Surgical Oncology, ESSO 36 CONFERENCE LOCATION Krakow, Poland CONFERENCE DATE 2016-09-14 to 2016-09-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Recent advances in the diagnosis and treatment of breast cancer have increased the complexity of therapeutic decisions. Thus, a multidisciplinary team (MDT) approach to breast cancer management should be a gold standard. The aim of this study was to evaluate MDT decision making and the impact of preoperative meetings on the treatment sequence and the extent of surgical breast and axilla operation in a newly formed breast unit within the regional comprehensive cancer centre. Material and methods: Breast cancer MDT management policy has been formally implemented in our institution since the January 2015. After completion of diagnostic process and defining disease stage each patient is appointed to outpatient counselling, examined by the consulting surgeon, and, if wants to be treated in our institution, referred to the breast MDT meeting before starting the therapy. Medical records of all referrals to MDT during first year of its operating were reviewed. Patients assessed by the surgeon as primarily operable entered the analysis. MDT decisions were compared to primary surgeon's decisions and classified as concordant and discordant. Details of discordant decisions were investigated. Results: There were 389 (84%) concordant and 74 (16%) discordant decisions. In 38 patients (8.2% of all, 51% of discordant) treatment sequence was changed by MDT, favouring preoperative systemic therapy: primary chemotherapy in 26 women (5.6%) and primary hormonotherapy in remained 12 (2.6%). In 36 patients (7.8% of all, 49% of discordant) surgical intervention with regard to breast or axilla was changed. Extent and type of breast operation was recommended on the basis of patient's preferences, surgical variables (lesion size and location, tumour size/breast volume ratio), radiological reassessment of mammograms, ultrasound reports and MRI (when appropriate) as well as the presence of contraindications to radiotherapy. Decision was discrepant in 30 (6.5%) women. For 22 (4.8%) patients mastectomy instead of breast conserving surgery was considered a preferable option. In contrast, 8 women (1.7%) were referred to breast conservation instead of mastectomy. In cases of disagreement in nodal assessment between clinicians and radiologist as well as when discrepant ultrasound reports were present axillary nodes were re-evaluated and fine-needle aspiration was completed. As a result, in 6 patients (1.3%) primary surgeon's decision regarding axillary procedure was changed. Four were referred to sentinel node biopsy instead of axillary dissection while in two others axillary dissection was recommended instead of primarily assumed sentinel node biopsy. Conclusions: Preoperative MDT meetings seem to be important in treatment decision-making process because the sequence of therapy as well as the type of surgical intervention can be changed in considerable rate of patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS axillary lymph node cancer center cancer size chemotherapy clinical article controlled study counseling decision making dissection doctor patient relation female fine needle aspiration biopsy human human tissue male mammography medical record nuclear magnetic resonance imaging outpatient partial mastectomy radiologist radiotherapy sentinel lymph node surgeon surgery systemic therapy tumor volume ultrasound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614692464 DOI 10.1016/j.ejso.2016.06.308 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.06.308 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 44 TITLE An Analysis of the Decisions Made for Contralateral Prophylactic Mastectomy and Breast Reconstruction AUTHOR NAMES Buchanan P.J. Abdulghani M. Waljee J.F. Kozlow J.H. Sabel M.S. Newman L.A. Chung K.C. Momoh A.O. AUTHOR ADDRESSES (Buchanan P.J.) Ann Arbor, Mich. From the Sections of Plastic Surgery and Surgical Oncology, Department of Surgery, University of Michigan Medical School (Abdulghani M.; Waljee J.F.; Kozlow J.H.; Sabel M.S.; Newman L.A.; Chung K.C.; Momoh A.O.) SOURCE Plastic and reconstructive surgery (2016) 138:1 (29-40). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Little is known about the role breast reconstruction plays in decisions made for contralateral prophylactic mastectomy. This study explores factors critical to patient medical decision-making for contralateral prophylactic mastectomy and reconstruction among women with early stage, unilateral breast cancer.METHODS: A mixed methods approach was used to gain an understanding of patients' choices and experiences. Patients with stage 0 to III unilateral breast cancer who underwent reconstruction were recruited, and semistructured interviews were conducted. Patient-reported outcomes were evaluated using the Concerns About Recurrence Scale and the BREAST-Q.RESULTS: Thirty patients were enrolled; 13 (43 percent) underwent unilateral mastectomy and 17 (57 percent) underwent contralateral prophylactic mastectomy. Three broad categories emerged from patient interviews: medical decision-making, quality of life after mastectomy, and breast reconstruction expectations. Patients who chose contralateral prophylactic mastectomy made the decision for mastectomy based primarily on worry about recurrence. Quality of life after mastectomy was characterized by relief of worry, especially in patients who chose contralateral prophylactic mastectomy [n = 14 (82.4 percent)]. Patients' desires for symmetry, although not the primary reason for contralateral prophylactic mastectomy, played a role in supporting decisions made. Levels of worry after treatment were similar in both groups (72.7 percent). Patients with contralateral prophylactic mastectomy had higher mean scores for satisfaction with breast (82.4 versus 70.6) and satisfaction with outcome (89.9 versus 75.2).CONCLUSIONS: The choice for contralateral prophylactic mastectomy is greatly influenced by fear of recurrence, with desires for symmetry playing a secondary role in decisions made. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient satisfaction procedures quality of life surgical flaps EMTREE MEDICAL INDEX TERMS adult aged breast reconstruction breast tumor (surgery) clinical decision making female human middle aged prevention and control prophylactic mastectomy questionnaire retrospective study tumor recurrence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27348637 (http://www.ncbi.nlm.nih.gov/pubmed/27348637) PUI L615743901 DOI 10.1097/PRS.0000000000002263 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002263 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 45 TITLE Evaluation of risk communication in a mammography patient decision aid AUTHOR NAMES Klein K.A. Watson L. Ash J.S. Eden K.B. AUTHOR ADDRESSES (Klein K.A., kleinkr@ohsu.edu; Watson L., watsolin@ohsu.edu; Ash J.S., ash@ohsu.edu; Eden K.B., edenk@ohsu.edu) Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, United States. CORRESPONDENCE ADDRESS K.A. Klein, Mail Code BICC,3181SW Sam Jackson Park Road, Portland, United States. Email: kleinkr@ohsu.edu SOURCE Patient Education and Counseling (2016) 99:7 (1240-1248). Date of Publication: 1 Jul 2016 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) cancer risk decision support system interpersonal communication mammography EMTREE MEDICAL INDEX TERMS adult article cancer screening comprehension confusion content analysis female human major clinical study medical decision making memory consolidation patient attitude predictive value pretest posttest design priority journal quantitative analysis risk assessment risk factor semi structured interview statistical analysis DEVICE TRADE NAMES Mammopad EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160191539 PUI L608829871 DOI 10.1016/j.pec.2016.02.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2016.02.013 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 46 TITLE Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review AUTHOR NAMES Knox A.D. Ho A.L. Leung L. Tashakkor A.Y. Lennox P.A. Van Laeken N. Macadam S.A. AUTHOR ADDRESSES (Knox A.D.) Vancouver, British Columbia, Canada From the Division of Plastic Surgery, University of British Columbia, Vancouver General Hospital, and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia (Ho A.L.; Leung L.; Tashakkor A.Y.; Lennox P.A.; Van Laeken N.; Macadam S.A.) SOURCE Plastic and reconstructive surgery (2016) 138:1 (16-28). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: There are few studies that compare the deep inferior epigastric artery perforator (DIEP) flap to the pedicled transverse rectus abdominis myocutaneous (pTRAM) flap for use in reconstructive breast surgery. The authors examined four factors that aid in decision-making: donor-site morbidity, need for surgery related to abdominal morbidity, operative time, and complications.METHODS: This is a retrospective review of patients undergoing breast reconstruction using the DIEP or pTRAM flap at the University of British Columbia between 2002 and 2013. The authors compared operative time and abdomen- and flap-related complications in both groups.RESULTS: Reconstruction was performed in 507 patients; 25.6 percent received DIEP flaps (n = 183 breasts) and 74.4 percent underwent pTRAM flap surgery (n = 444 breasts). Pedicled TRAM flap patients were more likely to require abdominal closure with mesh (44.2 percent versus 8.1 percent; p < 0.001); 21.2 percent of them had a postoperative bulge and/or hernia versus 3.1 percent of DIEP flap patients; and 12.7 percent of pTRAM flap patients required surgery for hernia/bulge. Controlling for confounders, there were five times the odds of a hernia/bulge in the pTRAM flap group. DIEP flap surgery was 234 minutes longer than pTRAM flap surgery.CONCLUSIONS: The benefits of the pTRAM flap may be offset by the need to correct abdominal wall complications. DIEP flap reconstruction had lower donor complications but increased operative time. A cost analysis is needed to determine the most economical procedure.CLINCIAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures transplantation vascularization EMTREE MEDICAL INDEX TERMS autotransplantation breast reconstruction breast tumor (surgery) epigastric artery female follow up human perforator flap rectus abdominis muscle retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26267400 (http://www.ncbi.nlm.nih.gov/pubmed/26267400) PUI L615778564 DOI 10.1097/PRS.0000000000001747 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001747 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 47 TITLE Effects of A Novel Decision Aid for Breast Reconstruction: A Randomized Prospective Trial AUTHOR NAMES Luan A. Hui K.J. Remington A.C. Liu X. Lee G.K. AUTHOR ADDRESSES (Luan A.) From the *Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA; and †Division of Plastic and Reconstructive Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (Hui K.J.; Remington A.C.; Liu X.; Lee G.K.) SOURCE Annals of plastic surgery (2016) 76 Supplement 3 (S249-S254). Date of Publication: 1 May 2016 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: The choice to undergo mastectomy and breast reconstruction is a highly personal decision with profound psychosocial effects, and ultimately, the decision between implant- and autologous tissue-based reconstruction should be made based on a combination of factual information and the patient's personal values and preferences. Unfortunately, patients undergoing breast reconstruction surgery may experience decision regret. Decision aids promote patient involvement in decision making by not only providing standard information about options, but also emphasizing comparative risks, benefits, and alternatives, and most importantly by providing clarification exercises regarding personal values to guide patients toward an individualized decision.METHODS: We developed a novel decision aid to provide decision support and structured guidance for prosthetic, autologous, and combined prosthetic-autologous breast reconstruction surgery. New breast reconstruction patients of one surgeon at our institution were randomized by week to either receive the decision aid or standard preconsultation material. Immediately preceding their new patient consultation clinic visit, patients were asked to complete the validated Decisional Conflict Scale and the BREAST-Q Preoperative survey. After 3 to 5 months following breast mound reconstruction, patients were asked to complete the Decision Regret Scale, BREAST-Q Postoperative survey, and the Hospital Anxiety and Depression Scale.RESULTS: Patients who received the decision aid demonstrated a trend toward decreased preoperative decisional conflict (mean of 13.3 ± 5.5, compared to 26.2 ± 4.2; n = 8 per group, P = 0.069), with similar preoperative BREAST-Q scores. Most patients desired to know "everything" regarding their reconstruction surgery (75%), and to be "very involved" in the decisions in their care (81%), with remaining patients wanting to know "as much as I need to be prepared" and to be "somewhat involved." Postoperatively, patients who received the decision aid demonstrated significantly less decision regret (P < 0.001), although there was no significant difference in anxiety, depression, or quality of life-related outcomes as measured by the BREAST-Q.CONCLUSIONS: The use of decision aids in breast reconstruction surgery may help decrease decisional conflict and regret through promoting improved information sharing and shared decision making, which are highly important in this particular setting, patient population, and in our move toward greater patient-centered care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system psychology statistics and numerical data EMTREE MEDICAL INDEX TERMS adult breast reconstruction controlled study female follow up human mastectomy middle aged patient care patient participation patient satisfaction procedures prospective study randomized controlled trial treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27070681 (http://www.ncbi.nlm.nih.gov/pubmed/27070681) PUI L616044725 DOI 10.1097/SAP.0000000000000722 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000722 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 48 TITLE Breast clinical nurse specialist perspective of decision support interventions AUTHOR NAMES Collins K. Wyld L. Burton M. Lifford K. Armitage F. AUTHOR ADDRESSES (Wyld L.; Lifford K.; Armitage F.) Sheffield University, Sheffield, United Kingdom. (Collins K.) Sheffield Hallam University, Sheffield, United Kingdom. (Burton M.) Cardiff University, Cardiff, United Kingdom. CORRESPONDENCE ADDRESS K. Collins, Sheffield Hallam University, Sheffield, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S8). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Treatment protocols for older women with breast cancer may vary from standard to accommodate co-morbidity and frailty. Supporting decision-making in older women may be challenging due to lack of informational resources and research evidence. We report development of tools to support shared decision making in older women from the perspective of the Clinical Nurse Specialist (CNS). Method: The information preferences of older women were studied using a multi-source intervention. CNS's, oncologists, surgeons, patients and healthy volunteers were recruited for questionnaires, audio recorded consultations, telephone and face to face interviews to determine the information needs of older women. Data were used to develop a series of decision support interventions (DESI's) to aid older women making breast cancer treatment decisions. These DESI's comprised patient booklets, a web based algorithm allowing clinicians to establish individual risks and option grids. User feedback on the tools was obtained to refine them further. Results: This abstract reports a re-interpretation of the data collected from a CNS perspective of the decision supports using framework analysis to identify common themes in the feedback to further refine the DESI's to facilitate clinical utility, acceptability, ease of use, practicality and facilitators and barriers to routine clinical practice. Conclusions: The decision tools were well received by CNSs whose feedback directed further amendments and addition of a 'frequently asked questions' section related to the sources and validity of underpinning data. This tool will now be tested as part of the Age Gap randomised trial. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer clinical nurse specialist decision support system EMTREE MEDICAL INDEX TERMS cancer therapy clinical practice clinical study consultation controlled clinical trial controlled study doctor patient relation female human interview oncologist questionnaire randomized controlled trial shared decision making surgeon telephone validity volunteer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540583 DOI 10.1016/j.ejso.2016.02.043 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.043 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 49 TITLE Psychosocial predictors of decision making for contralateral prophylactic mastectomy AUTHOR NAMES Brewster A.M. Peterson S.K. Bedrosian I. Dong W. Cantor S.B. Volk R.J. DuPont H.L. Shen Y. Parker P. AUTHOR ADDRESSES (Brewster A.M.; Peterson S.K.; Bedrosian I.; Dong W.; Cantor S.B.; Volk R.J.; DuPont H.L.; Shen Y.; Parker P.) The University of Texas MD Anderson Cancer Center, Houston, TX; Kelsey Research Foundation, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY CORRESPONDENCE ADDRESS A.M. Brewster, SOURCE Journal of Clinical Oncology (2016) 34 Supplement 15. Date of Publication: 1 May 2016 CONFERENCE NAME 2016 Annual Meeting of the American Society of Clinical Oncology, ASCO 2016 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2016-06-03 to 2016-06-07 ISSN 1527-7755 BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: For women with unilateral breast cancer, a surgical option is the removal of the cancer-free breast (contralateral prophylactic mastectomy, CPM). CPM among women with unilateral breast cancer is increasing despite the lack of evidence that it improves overall survival. There are limited data regarding factors associated with the decision to have CPM which limits the development of interventions to support informed decisionmaking. Methods: We recruited 343 women with newly diagnosed non-hereditary breast cancer prior to their first surgical consultation between 2012 and 2015. Women completed questionnaires assessing knowledge and level of interest in different surgical procedures including CPM, individuals with whom they discussed CPM and psychosocial factors. Results: The mean age of the participants was 56 years (range 25-82) and 48 women (14%) had CPM. Women were 57% white, 17% African American, 16% Hispanic, 10% other races. In univariate analyses, discussion of CPM with the medical oncologist (p = 0.03) and a strong interest in having mastectomy for the primary breast cancer (p < 0.001) were associated with CPM but discussion with the primary care provider (p = 0.63), spouses (p = 0.62) or breast cancer survivors (p = 0.45) was not associated with CPM. Women who had more breast cancer worry (p < 0.001), more intrusive thoughts about recurrence (p = 0.05), and more distress about body image (p = 0.003) were more likely to have CPM. In multivariable analysis, age (OR [odds ratio] 0.95, 95% CI [confidence interval] 0.91-0.99, p = 0.036 for every year increase in age), strong versus low interest in having mastectomy for the primary breast cancer (OR 12.16, 95% CI 1.53 -96.4, p = 0.02) and breast cancer worry (OR 1.17, 95% CI 1.10-1.36, p = 0.03 for every unit increase) remained significantly associated with CPM. Conclusions: Because of the important role that medical oncologists play in the decision making process of CPM, education regarding CPM should be focused on these providers in addition to surgeons. Addressing cancer worry among breast cancer patients is an area for intervention with decision support tools and counseling to ensure only patients most likely to derive clinical or psychosocial benefits will receive CPM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consensus development decision support system mastectomy EMTREE MEDICAL INDEX TERMS adult African American aged body image breast cancer cancer patient cancer survivor confidence interval consultation controlled study counseling diagnosis distress syndrome doctor patient relation education female Hispanic human major clinical study medical oncologist odds ratio primary medical care questionnaire race relapse spouse surgeon surgery surgical technique univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L611752602 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 50 TITLE An exploration of factors influencing reconstruction decisions in ethnic minority patients undergoing mastectomy for breast cancer AUTHOR NAMES Duxbury P. Donnelly L. Elgammal S. Jain A. Randhawa N. Harvey J. AUTHOR ADDRESSES (Duxbury P.; Donnelly L.; Jain A.; Harvey J.) Nightingale Centre, University Hospital of South Manchester, Southmoor Road, Wythensha we, Manchester, United Kingdom. (Elgammal S.) University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, United Kingdom. (Randhawa N.) University of Manchester, Oxford Road, Manchester, United Kingdom. CORRESPONDENCE ADDRESS P. Duxbury, Nightingale Centre, University Hospital of South Manchester, Southmoor Road, Wythensha we, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S26-S27). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Research within our tertiary referral breast unit has identified disparities in the treatment of breast cancer between Asians and Caucasians. Significantly fewer Asian patients chose to have breast reconstruction following mastectomy (34% Asian versus 62% Caucasian). The present study qualitatively explored factors influencing reconstructive decisions, following interviews with South Asian women. Methods: 42 participants were invited and 12 semi-structured interviews were carried out after REC approval. Topics identified for discussion by a focus group included reconstructive and cosmetic surgery, body image, cultural/religious influences, potential barriers in accessing information, and whether participants would make the same decision retrospectively. Thematic analysis was performed by Research Psychologists using the Framework approach. Results: Analysis identified a priority amongst these women to have their physical appearance reinstated, either by surgical or prosthetic means. Being available to maintain their roles and responsibilities within their families and wider community was also a driver in decision-making. Some were proactive in seeking further information about surgery. Most felt supported by an immediate family member or friend. Conclusions: The decision to have reconstructive surgery is complex and multifaceted. Women often expressed the desire to maintain their roles in the community by electing for less invasive surgery. Male partners have a significant influence on decision-making, and education of both men and women may improve reconstruction uptake. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer ethnic group mastectomy EMTREE MEDICAL INDEX TERMS body image clinical article decision making driver education esthetic surgery family female friend human male physical appearance psychologist reconstructive surgery responsibility semi structured interview South Asian surgery thematic analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540697 DOI 10.1016/j.ejso.2016.02.108 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.108 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 51 TITLE A randomized controlled trial of a risk based mammography screening decision aid for women 39-48 years of age AUTHOR NAMES Schapira M.M. Hubbard R. Seitz H. Conant E. Schnall M. Capella J. Harrington T. Inge C.A. Armstrong K. AUTHOR ADDRESSES (Schapira M.M.; Hubbard R.; Schnall M.; Harrington T.; Inge C.A.) University of Pennsylvania, Philadelphia, United States. (Seitz H.; Conant E.; Capella J.) Annenberg School of Communication, University of Pennsylvania, Philadelphia, United States. (Armstrong K.) Harvard University, Boston, United States. (Armstrong K.) Masssachusettes General Hospital, Boston, United States. CORRESPONDENCE ADDRESS M.M. Schapira, University of Pennsylvania, Philadelphia, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S105). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT BACKGROUND: Guidelines recommend that women in their 40's consider individual risk and personal values in deciding the age at which to begin breast cancer screening. However, it is unknown whether a decision aid (DA) that includes tailored risk information for younger women will increase the quality of decision making and impact the age at which women choose to start mammography screening. METHODS: We conducted a RCT in 2014-2015 to evaluate a web based decision aid (DA) delivered within a clinical practice network compared to usual care on knowledge, decisional conflict, and mammography intentions. Women were eligible if aged 39 to 48, enrolled in a participating primary care clinics (family practice, obstetrics and gynecology, and internal medicine), and had not had a previous mammogram. Recruitment took place in-clinic directly prior to the visit with randomization using concealed assignments occurring after obtainment of informed consent. A follow-up survey was conducted at 6 weeks. The DA tool was self-navigated by the patient, included risk estimates based on the NCI Breast Cancer Risk Assessment Tool, comparative risk information, value elicitation, and coaching to encourage shared decision making. Bivariate analysis was conducted to compare 3 pre-specified primary outcomes between groups; knowledge as measured on a 5-item scale (0-low to 5-high), decisional conflict as measured by the 16 item Decision Conflict Scale (DCS), and intended number of years before having a first mammogram. A p-value of 0.017 was considered significant. Exploratory analyses were conducted on outcomes of DC subdomains (Uncertainty, Informed, Values, Support, Effective Decision Making), anticipated regret, and breast cancer worry. RESULTS: There were 204 participants enrolled in the study; DA group (102) and control group (102) with 54.9 % (n = 112) completing the follow-up survey. The median age at the time of the follow-up survey was 40.1 years (range 39-49), 48 % were white, and 41 % were black. Ninety-one percent (91 %, n = 49) of women in the intervention group who completed the follow-up survey also completed the DA. At follow-up, knowledge (range 0-5) was greater in the DA vs. Control group (mean; difference, 95 %CI). (3.07 vs. 2.52, Diff: 0.57, 95 % CI: 0.14 to 0.98). A trend towards lower DCS scores was found in the DAvs. Control group (1.99 vs. 2.29, Diff: -0.30, 95 % CI: -0.63 to 0.38). There was no difference between groups in the intended number of years before having a first mammogram (2.6 vs. 1.6, Diff: 1.0, 95 %CI: -0.29 to 2.31). In exploratory analyses, women in the DA group trended towards decreased DCS scores in the Values domain (2.08 vs. 2.43, Diff: -0.36, 95 %CI: -0.73 to 0.01) and Support domain (1.83 vs. 2.13, Diff:-0.30, 95 %CI: -0.62 to 0.03). There was no difference in the other DCS subdomains. There was no difference between groups in anticipated regret (7 point scale from 1-low to 7-high) of not having a mammogram in your 40's and having cancer detected at a later date (5.45 vs. 5.70, Diff: -0.25, 95 %CI: -0.97 to 0.46) or having a mammogram in your 40's and facing unnecessary follow up tests or procedures: (3.47 vs. 3.28, Diff: 0.19, 95 %CI: -0.55 to 0.93). Breast cancer worry (1-low to 12-high) did not differ between groups (5.42 vs. 5.07, Diff: 0.36, 95 %CI: -0.36 to 1.07). CONCLUSIONS: A web based DA tailored to individualized risk and delivered in a practice setting increased knowledge and trended towards a decrease in decisional conflict when compared to a control of usual care. This study supports the use of a risk based DA to improve the quality of decision making regarding mammography initiation among younger women. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female human internal medicine mammography randomized controlled trial risk screening society EMTREE MEDICAL INDEX TERMS bivariate analysis breast cancer cancer risk cancer screening clinical practice control group decision making follow up general practice gynecology hospital informed consent neoplasm obstetrics patient patient worry personal value primary medical care procedures randomization risk assessment statistical significance LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72288168 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 52 TITLE Facilitating the delivery of patient-centered cancer care: Insights from the Patient-Centered Outcomes Research Institute's (PCORI) cancer portfolio AUTHOR NAMES Arora N.K. Gayer C. Lawrence W. Gershteyn V. Dunham K. Whitlock E. Clauser S. AUTHOR ADDRESSES (Arora N.K.; Gayer C.; Lawrence W.; Gershteyn V.; Dunham K.; Whitlock E.; Clauser S.) Patient-Centered Outcomes Research Institute, Washington, United States. CORRESPONDENCE ADDRESS N.K. Arora, Patient-Centered Outcomes Research Institute, Washington, United States. SOURCE Journal of Clinical Oncology (2016) 34 Supplement 15. Date of Publication: 1 May 2016 CONFERENCE NAME 2016 Annual Meeting of the American Society of Clinical Oncology, ASCO 2016 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2016-06-03 to 2016-06-07 ISSN 1527-7755 BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: PCORI funds comparative clinical effectiveness research (CER) that aims to produce evidence-based information to help people make informed health care decisions and improve outcomes that matter to patients. Cancer studies form one of the largest disease-specific PCORI-funded portfolios to date. Methods: We conducted a systematic analysis of PCORI's cancer portfolio. Results: As of October 2015, PCORI has funded 49 cancer projects totaling $131 million. Cancer studies account for 14% of PCORI's dollar investment in CER and are focusing on breast, lung, prostate, colorectal, cervical, ovarian, pancreatic, and hematologic cancers. A majority of studies are randomized trials (n = 28, 57%; 71% of dollar investment). Forty seven percent (23/49) compare the real world effectiveness of two or more interventions against each other and the remaining mostly compare an active intervention with usual care. Four studies are part of PCORI's large pragmatic clinical studies program accounting for 37% of our dollar investment in cancer. These studies include comparisons of cancer screening and surveillance protocols, approaches to radiation therapy, and protocols for managing the side-effects of chemotherapy. Each study in PCORI's cancer portfolio addresses important decisional dilemmas faced by patients, families, and clinicians throughout the cancer continuum from prevention, screening, diagnosis, treatment, post-treatment survivorship, and end of life. Interventions compared to address these dilemmas range from clinical approaches such as different screening protocols and treatment options, to decision support tools and patient decision-aids, to different models of organizing the delivery of care. Conclusions: PCORIfunded cancer studies are rigorously evaluating the real world impact of a range of interventions aimed at optimizing the delivery of patient-centered care. Our analysis of the cancer portfolio will synthesize the evidence gaps addressed by our studies, highlight how PCORI studies complement research funded by NIH, and help inform future PCORI efforts to improve patient-centered outcomes for cancer patients and families. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hematologic malignancy outcomes research EMTREE MEDICAL INDEX TERMS breast cancer cancer epidemiology cancer patient cancer screening chemotherapy clinical article clinical trial colorectal cancer comparative effectiveness controlled clinical trial decision support system diagnosis drug therapy family study female human investment lung cancer medical decision making model ovary cancer pancreas cancer patient care prevention prostate cancer radiotherapy randomized controlled trial side effect uterine cervix cancer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L611755736 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 53 TITLE An evidence-based patient handout for breast cancer screening shared decision making in primary care AUTHOR NAMES Ufomata E. Huang Y. Corbelli J. AUTHOR ADDRESSES (Ufomata E.; Corbelli J.) University of Pittsburgh Medical Center, Pittsburgh, United States. (Huang Y.) University of Pittsburgh, Pittsburgh, United States. CORRESPONDENCE ADDRESS E. Ufomata, University of Pittsburgh Medical Center, Pittsburgh, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S119). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT BACKGROUND: Breast cancer screening guidelines directly conflict regarding the recommended screening age of initiation and frequency of mammography. Specifically the United States Preventive Services Task Force recommends biennial screening starting at age 50, the American Cancer Society recommends yearly screening from age 45-50, and then biennially from age 50-74, and the American Congress of Obstetricians and Gynecologists recommend yearly screening at age 40. This controversy has created ongoing confusion among physicians and patients as to the optimal screening schedule for average-risk patients. Furthermore, many patients do not understand the potential harms associated with mammography, and research has shown that physicians are five times more likely to discuss potential screening benefits in comparison to harms with patients. Patient preferences, values and risk also vary widely, which further complicates patient counseling as to the optimal screening regimen on an individual level. Patients and physicians, therefore, are both poised to benefit from tools and processes to facilitate evidenced-based shared decision-making regarding breast cancer screening. Objectives Of Intervention: Increase patient knowledge of the risks and benefits of screening mammography Improve the processes of breast cancer screening shared decision making between patients and physicians METHODS: We created an evidence based patient handout for our General Internal Medicine Clinic at the university hospital, which consists of residents and attending physicians, and serves a large diverse patient population with respect to education, ethnicity, age and socioeconomic status. The handout details the benefits and harms of screening mammography in patient friendly language, which corresponds to an 8th grade Flesch-Kincaid grade level. It discusses key issues for a patient to consider when deciding to be screened between ages 40-50, including absolute risks of false positives leading to breast biopsy and further testing, over-diagnosis, and mortality benefit from screening mammography. It also discusses whether patients ages 50-74 should be screened yearly or biennially, but emphasizes that available guidelines consistently recommend that women in this age group should be screened. The handout was explicitly designed with the intention not to endorse one set of guidelines. Medical assistants distributed the handout to women ages 40 to 74, prior to the physician encounter, who were noted in the healthcare maintenance section of the medical record to be due for a mammogram discussion or who were scheduled for their annual exam. Patients were also given a survey to complete following their visit with the physician. The checkout staff collected the surveys which were independently completed by patients after the visit. If the patient decided to get a mammogram after leaving the clinic, they had the option to call clinic to have the mammogram order placed. Physicians were surveyed online after completion of the study. RESULTS: Patient Outcome Results 124 women completed the survey: 64%Caucasian, 29 % Black, 3.2 % Asian, 0 % Hispanic, and the remainder identified as other. Seventy two percent of the respondents were 50-74 years, 20%40-50 years; 8%were either older than 75 or did not identify their age. The population was more highly educated than the general population: 73 % had at least some college education, with 32 % having postgraduate degrees. For women aged 50-74, 38 % who planned to get annual mammograms, decided to screen biennially after using the handout in discussion with their physician, while 14 % of women who planned to get biennial mammograms, changed their mind to opt for annual screen Women who changed their minds were significantly more likely to opt for biennial screening vs. annual screening (p = 0.04). 64.2 % reported that they learned new information from the handout, and 74.8% reported that the handout increased their comfort with the discussion of screening mammography. Physician Outcome Results 20 physicians completed the survey: 65 % were attendings, and 70 % were women. Eighty percent of respondents agreed that they would use this handout in the future, 80 % of respondents reported that the handout was helpful when counseling patients aged 40-49, compared to 100 % of respondents who reported that the handout was helpful when counseling patients aged 50-74. Eighty-five percent of respondents agreed handout was informative for them. One hundred percent of physicians reported that breast cancer screening required shared decision-making. CONCLUSIONS: This intervention was well received by both patient and physicians, who found it helpful in facilitating mammography shared decision-making, which was the primary aim of the study. The purpose of the intervention was explicitly not to endorse one set of guidelines; given this, it is particularly notable that over half of women ages 50-74 changed their minds about their desired screening interval after reading the handout. Most participants who changed their minds opted for decreased screening. These results are consistent with prior literature, which shows that patients are not adequately informed about mammography options and potential harms of screening. Overall, this intervention was very low cost and can be implemented at practices of varying size and type to facilitate processes of shared decision-making regarding breast cancer screening. Our results indicate that both patients and physicians benefit from decision aids when discussing breast cancer screening. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer screening decision making evidence based practice human internal medicine patient primary medical care society EMTREE MEDICAL INDEX TERMS American Asian breast biopsy Caucasian college comfort counseling diagnosis education ethnicity female groups by age gynecologist health care Hispanic hospital hospital patient language mammography medical assistant medical record mortality non profit organization obstetrician patient counseling patient preference physician population postgraduate student preventive health service reading risk screening social status United States university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72288195 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 54 TITLE When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret AUTHOR NAMES Nicolai J. Buchholz A. Seefried N. Reuter K. Härter M. Eich W. Bieber C. AUTHOR ADDRESSES (Nicolai J., nicolai@uni-mannheim.de; Seefried N.; Eich W.; Bieber C.) Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany. (Nicolai J., nicolai@uni-mannheim.de) Psychology III, University of Mannheim, Germany. (Buchholz A.; Härter M.) Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. (Reuter K.) Department of Psychiatry and Psychotherapy, University of Freiburg, Germany. CORRESPONDENCE ADDRESS J. Nicolai, Psychology III, University of Mannheim, EO 238, Mannheim, Germany. Email: nicolai@uni-mannheim.de SOURCE Patient Education and Counseling (2016) 99:5 (739-746). Date of Publication: 1 May 2016 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objective: To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. Methods: Patients with breast or colon cancer (n = 71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. Results: After controlling for clinician clusters, higher PE was directly associated with more SDM (β = 0.43, p < 0.01) and lower decision regret (β = -0.28, p < 0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β = -0.33, p < 0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β = 0.03, p = 0.74). Conclusion: PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. Practice implications: Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient medical decision making EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (diagnosis) cancer cell cancer diagnosis colon cancer (diagnosis) consultation controlled study demography female human major clinical study male parallel design path analysis patient satisfaction priority journal prospective study questionnaire very elderly EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151027067 MEDLINE PMID 26658703 (http://www.ncbi.nlm.nih.gov/pubmed/26658703) PUI L607249292 DOI 10.1016/j.pec.2015.11.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2015.11.019 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 55 TITLE Dense breast notifications: Varying content, readability, and understandability by state AUTHOR NAMES Kressin N.R. Gunn C.M. Battaglia T.A. AUTHOR ADDRESSES (Kressin N.R.) VA Boston Healthcare System, Boston, United States. (Kressin N.R.; Gunn C.M.; Battaglia T.A.) Boston University, School of Medicine, Boston, United States. CORRESPONDENCE ADDRESS N.R. Kressin, VA Boston Healthcare System, Boston, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S175-S176). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT BACKGROUND: Along with their screening mammogram results, women in 23 states now also receive notifications of breast density. Dense breasts can mask cancer on mammography (masking bias), and are an independent cancer risk factor, but evidence does not yet indicate whether or what supplemental screening is appropriate. Rather, risk stratification is proposed to determine who may benefit from supplemental screening. Dense breast notification (DBN) text may affect women's ability to understand their message. Thus, we examined DBN characteristics across states, to inform future policy. METHODS: We compared the content, readability, and understandability of DBNs across states, noting the mention of supplemental screening, masking bias, density as a cancer risk factor, and required recipients. We measured readability using the Flesch- Kincaid reading level in MS Word and the Dale-Chall readability score, and assessed understandability using the Patient Education Materials Assessment Tool. We obtained the proportion of adults in each state lacking basic prose literacy skills from available statistics, comparing DBN readability with state population literacy level. RESULTS: Most states (n = 19, 83 %) mandate specific language; while 4 (17 %) only mandate required components. Seven states (30 %) require a generic DBN for every woman receiving a screening mammogram (others only require notification to those with dense findings). All DBNs mention masking bias, 17 (74 %) mention the association with increased cancer risk, 21 (91 %) mention 'supplemental screening' as an option (using at least that term), advising women to consult their physician. Of 17 states requiring specific language regarding supplemental screening, 6 (35 %) inform women that they might benefit from such screening; 4 mention specific modalities. Flesch-Kincaid readability levels ranged from grades 7-19.4 (mean: 11.1), most exceeding the recommended literacy level (grades 7-8); about 20 % of the population reads below a grade 5 level. Dale-Chall readability scoring produced slightly higher scores overall (range: grades 9-10-13-15). All DBNs scored poorly on understandability (PEMAT; range: 11-33 %). There was widespread discordance between states' DBN readability and corresponding basic literacy levels. Only 3 states' DBN literacy level fell <8th grade; some of the highest DBN readability levels occurred where state literacy levels are lowest. CONCLUSIONS: We found wide variation in 23 states' DBN content, with generally poor readability and understandability, and discordance with states' average literacy. Such incomprehensible patient notifications may create uncertainty for women attempting to make personalized decisions about supplemental screening, leading to increased supplemental screening utilization for higher literacy populations, which has the potential to further exacerbate existing disparities in breast cancer diagnosis and outcomes. These findings add to other expressed concerns regarding DBN reporting laws. Inconsistencies in DBN content may reflect the lack of evidence regarding supplemental screening, and may confuse women comparing health information across state lines (e.g., sisters with similar anatomy receiving different information). Many DBNs appropriately encourage discussions and shared decision making between patients and doctors. However, this alone is insufficient to produce shared decision making, enable time-pressured physicians to explain results and conduct personalized risk assessments, or provide clinical decision support to do so. Given the generally poor readability of the current DBNs, and incompatibility with documented literacy of the general population, efforts should focus on enhancing the understandability of such messages, so that all women are clearly and accurately informed about their density status, its impact on their breast cancer risk, and the harms and benefits of supplemental screening. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast internal medicine reading society EMTREE MEDICAL INDEX TERMS adult breast cancer breast density cancer diagnosis cancer risk decision making decision support system density female human language mammography medical information neoplasm patient patient education physician policy population recipient risk risk assessment risk factor screening skill statistics stratification LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72288294 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 56 TITLE Computational models deriving tumour to breast volume ratios from two-view mammography may aid oncoplastic decision-making AUTHOR NAMES Rimmer S. Yang C. Seaton T. MacNeill F. Lee S.-L. Leff D. AUTHOR ADDRESSES (Leff D.) Department of Surgery and Cancer, Imperial College London, London, United Kingdom. (Rimmer S.; Seaton T.; Leff D.) Breast Unit, Imperial College Healthcare NHS Trust, London, United Kingdom. (MacNeill F.) Breast Unit, Royal Marsden, London, United Kingdom. (Yang C.; Lee S.-L.) Hamlyn Centre, Imperial College London, London, United Kingdom. CORRESPONDENCE ADDRESS S. Rimmer, Breast Unit, Imperial College Healthcare NHS Trust, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S28). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Breast conserving surgery (BCS) is the preferred strategy in the surgical treatment of breast cancer given the improved quality of life versus mastectomy. Decisions regarding suitability for BCS versus mastectomy are complex and include clinical and radiological assessment( s) combined with operator experience to judge resection volume and predict cosmetic outcomes. Algorithmic solutions for determining tumour: breast volume are objective and may aid clinical-decision making. Methods: We developed methods using machine learning algorithms (Partial Least Squares Regression, Primary Component Regression, and Regression Tree), to compute breast volume, tumour volume and %tumour: breast volume ratios from two-view mammography images (CC, MLO) acquired in 17 patients. We then identified 25 consecutive breast cancer patients and calculated breast and tumour volume, % tumour: breast volume ratio and compared predicted surgical decisions (based on estimated % resection) with actual surgical decisions. Results: The mean % tumour: breast volume did not significantly vary between algorithms [PSLR=8.01, PCR=8.33, RT=9.02, χ(2)=5.12, p=0.77]. Of the 25 patients, 19 had data regarding definitive operative decisions, of which 42.1%(n=8) aligned with predictions, and 57.8%(n=11)were discordant. Of discordant cases, 10 patients underwent mastectomy despite relatively low mean % tumour: breast volume ratios (3.37-5.03%). One patient underwent BCS followed by re-excision of margins despite an estimated % tumour: breast volume of >20%(51-59%). Conclusions: Algorithms that detect tumour and breast volume may make surgical decision-making more objective, based on more realistic estimates of resection volumes. Further work is required to determine significance of the discordance between predicted actual surgical decision making focusing on repeat procedures and cosmesis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer size decision making female mammography tumor model EMTREE MEDICAL INDEX TERMS cancer patient clinical article controlled study esthetic surgery human machine learning partial least squares regression partial mastectomy polymerase chain reaction prediction repeat procedure surgery surgical margin tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540771 DOI 10.1016/j.ejso.2016.02.114 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.114 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 57 TITLE Management of lobular carcinoma in situ: A decision analysis AUTHOR NAMES Wong S.M. Stout N.K. Punglia R.S. Golshan M. AUTHOR ADDRESSES (Wong S.M.; Stout N.K.; Punglia R.S.; Golshan M.) McGill University Health Centre, Montreal, QC, Canada; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA CORRESPONDENCE ADDRESS S.M. Wong, SOURCE Journal of Clinical Oncology (2016) 34 Supplement 15. Date of Publication: 1 May 2016 CONFERENCE NAME 2016 Annual Meeting of the American Society of Clinical Oncology, ASCO 2016 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2016-06-03 to 2016-06-07 ISSN 1527-7755 BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Women diagnosed with lobular carcinoma in situ (LCIS) have a three to tenfold increased risk of developing invasive breast cancer, and controversy remains regarding the best strategy for management of this diagnosis. We sought to evaluate the life expectancy and survival differences offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy (BPM). Methods: We constructed a Markov simulation model to determine life expectancy (LE) gains and survival for hypothetical cohorts of women diagnosed with LCIS at age of 40, 50 and 60 under alternative risk-reduction strategies. Probabilities for invasive breast cancer, breast cancerspecific mortality, effectiveness of preventive strategies and complication rates were derived from published studies and the Surveillance, Epidemiology and End Results database. Sensitivity analyses were performed to evaluate the stability of results to changes in model parameters. Results: Assuming a breast cancer incidence of 1-2% per year under active surveillance, a 50-year-old woman diagnosed with LCIS would have a total LE of 31.6-32.3 years, and would gain 0.32-0.64 years in LE by adding chemoprevention and 0.70-1.28 years by BPM. In our model, the largest gains were seen in young women aged 40-years at diagnosis, while increasing age at diagnosis attenuated gains associated with active prevention strategies. Ten-year overall survival (OS) with active surveillance ranged from 96.1-97% if diagnosed at 40-years, 93.6-94.5% at 50-years, and 88.5-89.3% at 60-years. Absolute percent differences in overall survival ranged from 0.5-1.1% with chemoprevention and 0.7-1.7% with BPM. Conclusions: Among women with a diagnosis of LCIS, LE gains were seen for risk-reducing strategies such as chemoprevention and BPM, particularly in younger women. Coupled with information about the potential side effects associated with each management strategy, these results may be useful to help guide women and their physicians in the decision making process. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma EMTREE MEDICAL INDEX TERMS adult breast cancer cancer incidence case report chemoprophylaxis consensus development data base decision making diagnosis disease simulation doctor patient relation female human life expectancy mastectomy mortality overall survival prevention probability risk reduction side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L611752574 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 58 TITLE Use of comprehensive systems support to improve chronic disease management and cancer screening AUTHOR NAMES Sequeira S.S. Mcnamara J. Yang E. D'Afflitti J. Mishuris R.G. AUTHOR ADDRESSES (Sequeira S.S.; D'Afflitti J.; Mishuris R.G.) Boston University, School of Medicine, Boston, United States. (Mcnamara J.; Yang E.) Boston University Medical Center, Boston, United States. CORRESPONDENCE ADDRESS S.S. Sequeira, Boston University, School of Medicine, Boston, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S918-S919). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): The national focus on high quality, patient centered care, coupled with clinician burnout, makes developing non-provider dependent systems that support point of care chronic disease monitoring and cancer screening a high priority OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): Increase the rates of recommended routine monitoring for patients with type 2 diabetes mellitus (hemoglobin A1c testing), influenza vaccination, and routine cancer screening (cervical, breast and colon cancers) in an urban safety net hospital-based adult primary care clinic. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): We developed a multi-dimensional program that involved medical assistants and clinicians to address these preventive care measures in an urban safety net hospital-based adult primary care clinic. This program is based on evidence from a pilot study which showed that increased operational, navigational and data sharing support at the point of care improved the delivery of preventive services. In addition to the electronic clinical reminders presented to the medical assistants and clinicians in the form of best practice alerts (BPAs) within the electronic medical record (EMR), this program was built around a daily report of scheduled patients due for preventive services. Medical assistants used these opportunity reports as decision support to determine patients who were overdue for cancer screening (based on USPSTF guidelines) and patients with diabetes who were overdue for HbA1c testing (based on ADA guidelines). The opportunity reports were used in pre-visit care team huddles to plan for completion of routine screening tests at the point of care and also triggered non-clinician dependent workflows such as automatic HbA1c testing by medical assistants for patients who are overdue. Performance reports on rates of patients with up to date HbA1c testing were provided monthly to the entire practice to compare and track performance over time. Cancer screening performance reporting is currently in process. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/ INTERVENTION): Number of eligible patients with completed HbA1c testing, number of eligible patients completing influenza vaccination, and number of eligible patients completing cancer screening. FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): The percentage of eligible diabetic patients who were compliant with guideline recommended HbA1c testing for the entire practice rose from an average of 84.2% pre-intervention to 91.7% with the intervention. Clinicians and Medical Assistants reported improved care team communication, which included agenda setting for patient visits and care team huddles. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): 1) Employing non-provider dependent workflows unburdens providers, enhances the non provider role in patient care and promotes team based care; 2) Providing up to date, consumable process and outcome metric reporting to the practice allows for identification of best practices and areas to improve, and had the greatest impact on our improvement in rates of HbA1c monitoring; 3) using point of care interventions is more patient -centered and efficient. EMTREE DRUG INDEX TERMS hemoglobin hemoglobin A1c EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening chronic disease disease management internal medicine society EMTREE MEDICAL INDEX TERMS adult breast burnout colon cancer decision support system diabetes mellitus diabetic patient electronic medical record hospital hospital patient human influenza vaccination interpersonal communication medical assistant monitoring non insulin dependent diabetes mellitus patient patient care pilot study preventive health service primary medical care safety net hospital screening test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72289686 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 59 TITLE Best practices for communicating proportion data to patients AUTHOR NAMES Snyder C.F. Tolbert E.E. Smith K. Bantug E. Blackford A.L. Brundage M. AUTHOR ADDRESSES (Snyder C.F.) Johns Hopkins School of Medicine, Baltimore, United States. (Brundage M.) Queen's University, Kingston, Canada. (Tolbert E.E.; Smith K.) Johns Hopkins Bloomberg School of Public Health, Baltimore, United States. (Snyder C.F.; Smith K.; Bantug E.; Blackford A.L.) Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, United States. CORRESPONDENCE ADDRESS C.F. Snyder, Johns Hopkins School of Medicine, Baltimore, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S139-S140). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT BACKGROUND: Patient-reported outcomes (PRO) (e.g., symptoms, quality-of life) are frequently measured in clinical trials and research studies comparing treatment options. Endpoints are commonly communicated as proportions (e.g., % improved, stable, worsened), but little is known regarding how to graphically present these data to patients most effectively. We tested the accuracy of interpretation and clarity ratings of three types of graphic displays for communicating PRO data expressed as proportions in patient educational materials and decision aids. METHODS: This mixed-methods study included an internet survey circulated to distribution lists of cancer patients/survivors (age 21+), cancer providers, and PRO researchers using snowball techniques, supplemented with one-on-one in-person interviews with cancer patients/survivors and providers. The one-on-one interviewees were recruited from the Johns Hopkins Clinical Research Network (a consortium of academic and community-based health systems in the mid-Atlantic) and were purposively sampled based on education and cancer type (patients) and specialty (providers). For both the internet survey and one-on-one interviews, respondents were shown three approaches for presenting proportions: pie charts, bar graphs, icon arrays. Format presentation order was randomized to control for order effects. For each format, respondents were asked questions evaluating the accuracy of data interpretation (2 questions on the first format seen and 1 question on each of the following two formats), and also rated the format's clarity (very clear, somewhat clear, somewhat confusing, very confusing). At the end, respondents were asked to pick the proportion format “most useful for showing...patient's results.” The one-on-one interviewees were asked to “think aloud” as they responded to the online survey. The quantitative internet data were summarized descriptively. Multivariable logistic regression models estimated using generalized estimating equations (GEE) were used to analyze differences in accuracy of interpretation and clarity ratings by format. Chisquare tests evaluated differences in whether proportions were selected as “most useful.” The one-on-one interview qualitative data informed our interpretation of the quantitative internet survey results. RESULTS: Internet survey data from 649 respondents included 362 patients, 104 providers, and 183 researchers. Patients were 57 years old, on average, 95 % white, 85 % female, 26 % < college graduate, and 48 % breast cancer. Providers had a mean age of 43 with a mean 15 years in practice. Researchers were an average age of 44 with 49 % having >10 years experience. One-on-one interviews were conducted with 10 patients (30 % < college graduate) and 5 providers representing various cancer specialties. The table shows the descriptive results of the percentage of patients, providers, and researchers who got both questions correct for the first format seen, the percentage rating each format “somewhat” or “very” clear, and the percentage selecting each format as “most useful”. In the multivariable logistic regression GEE models, across the 4 accuracy questions for each format, bar graphs were less accurately interpreted than pie charts (odds ratio [OR] = 0.49; 95 % confidence interval [95 % CI] = 0.35-0.67; p < .0001) and icon arrays (OR = 0.43; 95 % CI = 0.31- 0.60; p < .0001). There were no statistically significant differences between icon arrays and pie charts in accuracy of interpretation. Bar graphs and icon arrays were less likely to be rated clear than pie charts (OR = 0.35; 95 % CI = 0.25- 0.49 and OR = 0.19; 95 % CI = 0.13-0.25, respectively; both p < .0001), and bar graphs were more likely to be rated clear than icon arrays (OR = 1.90; 95 % CI = 1.47-2.45; p < .0001). Pie charts were most often selected as “most useful” by patients (67 %; chi-square p < .001) and providers (43 %; chi-square p = .02), with no significant preference found for researchers. CONCLUSIONS: Pie charts were more accurately interpreted than bar graphs, and were more likely to be rated clear and to be selected as “most useful” than either bar graphs or icon arrays. These data suggest that pie charts are the most effective approach for conveying proportion data accurately and clearly. Further research should investigate the generalizability of these findings beyond patient-reported outcomes data and in non-cancer populations. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human internal medicine patient society EMTREE MEDICAL INDEX TERMS breast cancer clinical research clinical trial (topic) community confidence interval education female graduate health care hospital patient Internet interview logistic regression analysis model neoplasm population quality of life risk scientist LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72288232 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 60 TITLE A systematic review of decision aids for patients making a decision about treatment for early breast cancer AUTHOR NAMES Zdenkowski N. Butow P. Tesson S. Boyle F. AUTHOR ADDRESSES (Zdenkowski N., nicholas.zdenkowski@anzbctg.org; Boyle F.) Faculty of Medicine, University of Sydney, Australia. (Zdenkowski N., nicholas.zdenkowski@anzbctg.org; Boyle F.) Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia. (Butow P.; Tesson S.) Psycho-oncology Co-operative Research Group (PoCoG), Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, Australia. (Boyle F.) Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, Australia. CORRESPONDENCE ADDRESS N. Zdenkowski, Australia and New Zealand Breast Cancer, Trials Group, HRMC, PO Box 155, , Australia. Email: nicholas.zdenkowski@anzbctg.org SOURCE Breast (2016) 26 (31-45). Date of Publication: 1 Apr 2016 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid.A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer early cancer general medical device medical decision making treatment decision aid EMTREE MEDICAL INDEX TERMS adjuvant therapy anxiety disorder audiotape decision aid cancer chemotherapy cancer radiotherapy cancer surgery clinical effectiveness computer system decision support system depression fertility preservation hormonal therapy human interactive computer system intermethod comparison Internet knowledge mastectomy outcome assessment partial mastectomy patient satisfaction priority journal prophylactic mastectomy prophylactic surgical procedure randomized controlled trial (topic) review systematic review systemic therapy workbook decision aid EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160246363 PUI L609167812 DOI 10.1016/j.breast.2015.12.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2015.12.007 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 61 TITLE Shared decision making in daily practice in early stage breast cancer care; how to make it work AUTHOR NAMES Savelberg W. Smidt M. Boersma L. Ubbink D. Bessems M. Van Der Meij S. Moser A. Haekens C. Van Der Weijden T. AUTHOR ADDRESSES (Savelberg W.; Smidt M.; Haekens C.) Maastricht University Medical Centre, Oncology, Maastricht, Netherlands. (Boersma L.) Maastricht University Medical Centre, Radiotherapy, Maastricht, Netherlands. (Ubbink D.; Van Der Meij S.) Academisch Medisch Centrum, Universiteit Van Amsterdam, Surgery, Amsterdam, Netherlands. (Bessems M.) Jeroen Bosch Ziekenhuis, Surgery, Den Bosch, Netherlands. (Moser A.) Zuyd University of Applied Sciences, Health Care, Heerlen, Netherlands. (Van Der Weijden T.) Maastricht University, School for Public Health and Primary Care, Maastricht, Netherlands. CORRESPONDENCE ADDRESS W. Savelberg, Maastricht University Medical Centre, Oncology, Maastricht, Netherlands. SOURCE European Journal of Cancer (2016) 57 SUPPL. 2 (S31). Date of Publication: April 2016 CONFERENCE NAME 10th European Breast Cancer Conference, EBCC-10 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2016-03-09 to 2016-03-11 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Breast conserving therapy and mastectomy have been shown equally effective in early stage breast cancer, indicating that the patient's preference may dominate the decision. At the time of diagnosis, each patient has her own values, concerns and knowledge, which influence her treatment preferences. Shared decision making (SDM) is regarded as a promising model to achieve a personalised treatment plan. Nevertheless, SDM has not yet been implemented widely. Evidence shows that physicians feel that they already apply SDM, or that patients prefer to rely on the doctor's advice instead of being involved or that they feel they lack time or skills to offer a balanced presentation of medical options including all pros and cons. There is evidence that a patient decision aid may support SDM, by facilitating neutral discussion and deliberation about treatment options. The aim of the study, with pre and post intervention measurements, was to evaluate SDM in clinical practice. Method: We developed an implementation strategy for SDM, including a patient decision aid. We piloted the implementation in dedicated breast cancer teams in four hospitals, by measuring performance indicators and experiences of both professionals and patients. We invited each hospital to include 10 patients in the pre-implementation as well as in the post-implementation phase. We collected qualitative data by interviewing professionals about barriers and facilitators for change, quantitative data of patient involvement in decision making by audiotaping consultations using the OPTION 5-item instrument on objective scoring and questioning patients after the treatment decision was made using a 18-item patient knowledge test, the 16-item decisional conflict scale, and the patients' perception of SDM using the 9-item SDM-Q9 scale. Results: Qualitative data: Professionals reported insufficient awareness of what SDM is and stated that integration of SDM within the entire breast cancer team is needed to normalize SDM in the routine setting. Quantitative data: Table gives preliminary results. SDM, patients' knowledge and decisional conflict tend to slightly improve. Conclusion: Compared with global data from other studies the breast cancer professionals show relatively good performance, but there is still ample room for improving SDM. Integrating SDM into the daily routines of the multidisciplinary tumor board and in clinical practice calls for thoughtful, mainly organizational, changes. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision making European EMTREE MEDICAL INDEX TERMS breast clinical practice consultation diagnosis hospital human mastectomy model neoplasm patient patient participation patient preference physician skill therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72220567 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 62 TITLE A treatment threshold for decision making in breast cancer surgery for optimal quality of life AUTHOR NAMES Vos E. Koppert L. Van Lankeren W. Groot Koerkamp B. Hunink M. AUTHOR ADDRESSES (Vos E.; Koppert L.; Groot Koerkamp B.) Erasmus MC Cancer Institute, Surgery, Rotterdam, Netherlands. (Van Lankeren W.; Hunink M.) Erasmus MC, Radiology, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS E. Vos, Erasmus MC Cancer Institute, Surgery, Rotterdam, Netherlands. SOURCE European Journal of Cancer (2016) 57 SUPPL. 2 (S77). Date of Publication: April 2016 CONFERENCE NAME 10th European Breast Cancer Conference, EBCC-10 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2016-03-09 to 2016-03-11 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Since survival after breast conserving surgery (BCS) and mastectomy is equivalent, the choice for early stage breast cancer patients may rest upon quality of life (QoL) and cosmetic result considerations. It is believed that BCS entails a QoL benefit over mastectomy if a superior cosmesis is achieved, otherwise mastectomy may be preferred especially when considering breast reconstruction. The preoperative prediction of the cosmetic result after therapy should aid informed treatment decision making. Our aim was to determine the optimal threshold in the preoperative prediction of achieving superior cosmesis after BCS based on tumour volume versus breast volume ratio and location of the tumour in the breast. If the prediction exceeds the threshold, BCS will result in optimal QoL and if below the threshold, mastectomy will result in optimal QoL. Methods: A previously published study population was used of 69 invasive breast cancer women treated with breast conserving therapy and their long-term cosmetic result was evaluated by a panel. A preoperative prediction model was determined by logistic regression analysis to predict superior cosmesis after BCS representing our test with an area under the curve of 0.827 (95% CI 0.71-0.94). A decision tree for our test was built modelling the treatment consequences resulting in health states. To each health state a utility value (QoL weight on a 0-1 scale) was attached derived from the literature (for mastectomy) and our study population (for BCS). The treatment threshold - to perform BCS or not - was defined by the probability of superior cosmetic result after BCS at which the QoL of patients living with BCS and mastectomy is equal, which can be determined by direct comparison of the benefits and harms of BCS. The benefit was defined as the gain in QoL from superior cosmesis after BCS instead of mastectomy (with or without reconstruction) and the harm was defined by the loss in QoL from inferior cosmesis after BCS instead of mastectomy (with or without breast reconstruction). Results: The health states were: BCS with superior cosmesis, BCS with inferior cosmesis, mastectomy only, and mastectomy with breast reconstruction. Their utility values were 0.898, 0.862, 0.891, and 0.859 respectively. The breast reconstruction rate after mastectomy was 41.5% resulting in a utility for mastectomy (with or without reconstruction) of 0.877. The treatment threshold - to treat with BCS or not - was 0.462. Conclusions: The threshold of treatment with BCS versus mastectomy can be used in a preoperative treatment decision aid for breast cancer surgery with QoL as the primary outcome that incorporates the expected cosmetic result after BCS. Further improvement of the decision aid requires the more frequent use of utility values as part of QoL measurements in breast cancer patients. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery decision making European quality of life EMTREE MEDICAL INDEX TERMS area under the curve breast breast reconstruction cancer patient decision tree female health status human logistic regression analysis mastectomy model neoplasm partial mastectomy patient population prediction preoperative treatment survival therapy tumor volume weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72220711 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 63 TITLE Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer AUTHOR NAMES Hawley S.T. Newman L. Griggs J.J. Kosir M.A. Katz S.J. AUTHOR ADDRESSES (Hawley S.T., sarahawl@umich.edu; Griggs J.J.; Katz S.J.) Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, United States. (Newman L.) Department of Surgery, University of Michigan, Ann Arbor, United States. (Kosir M.A.) Karmanos Cancer Institute, Detroit, United States. (Hawley S.T., sarahawl@umich.edu) Ann Arbor VA Healthcare System, Ann Arbor, United States. CORRESPONDENCE ADDRESS S.T. Hawley, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, United States. Email: sarahawl@umich.edu SOURCE Patient (2016) 9:2 (161-169). Date of Publication: 1 Apr 2016 ISSN 1178-1661 (electronic) 1178-1653 BOOK PUBLISHER Springer International Publishing ABSTRACT Background: Early-stage breast cancer patients face a series of complex treatment decisions, with the first typically being choice of locoregional treatment. There is a need for tools to support patients in this decision-making process. Methods: We developed an innovative, online locoregional treatment tool based on International Patient Decision Aids Standards criteria. We evaluated its impact on patient knowledge about treatment and appraisal of decision making in a pilot study using a clinical sample of newly diagnosed, breast cancer patients who were randomized to view the decision aid website first or complete a survey prior to viewing the decision aid. Differences in knowledge and decision appraisal between the two groups were compared using t-tests and chi-square tests. Computer-generated preferences for treatment were compared with patients’ stated preferences using chi-square tests. Results: One hundred and one newly diagnosed patients were randomized to view the website first or take a survey first. Women who viewed the website first had slightly higher, though not significantly, knowledge about surgery (p = 0.29) and reconstruction (p = 0.10) than the survey-first group. Those who viewed the website first also appraised their decision process significantly more favorably than did those who took the survey first (p < 0.05 for most decision outcomes). There was very good concordance between computer-suggested and stated treatment preferences. Conclusion: This pilot study suggests that an interactive decision tool shows promise for supporting early-stage breast cancer patients with complicated treatment decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system patient decision making EMTREE MEDICAL INDEX TERMS adult aged article cancer patient cancer staging chi square test clinical assessment tool clinical evaluation controlled study female health survey human knowledge major clinical study patient preference priority journal randomized controlled trial Student t test EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015197180 MEDLINE PMID 26178202 (http://www.ncbi.nlm.nih.gov/pubmed/26178202) PUI L605198449 DOI 10.1007/s40271-015-0135-y FULL TEXT LINK http://dx.doi.org/10.1007/s40271-015-0135-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 64 TITLE Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review AUTHOR NAMES Munro S. Stacey D. Lewis K.B. Bansback N. AUTHOR ADDRESSES (Munro S., smunro@cfri.ca; Bansback N.) Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada. (Munro S., smunro@cfri.ca) University of British Columbia, Vancouver, Canada. (Stacey D.; Lewis K.B.) School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. (Stacey D.; Lewis K.B.) Ottawa Hospital Research Institute, Ottawa, Canada. (Bansback N.) School of Population and Public Health, University of British Columbia, Vancouver, Canada. (Bansback N.) Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada. CORRESPONDENCE ADDRESS S. Munro, University of British Columbia, H.R. MacMillan Building, 2357 Main Mall, Vancouver, Canada. Email: smunro@cfri.ca SOURCE Patient Education and Counseling (2016) 99:4 (491-500). Date of Publication: 1 Apr 2016 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objective: To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation. Methods: A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Results: Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n = 3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n = 8). Conclusion: Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures. Practice Implications: Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices. EMTREE DRUG INDEX TERMS estrogen (drug therapy) progesterone (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system patient care patient decision aid patient decision making screening choice treatment choice value congruent decision-making EMTREE MEDICAL INDEX TERMS angiocardiography bariatric surgery breast cancer (diagnosis) cancer screening colorectal cancer (diagnosis) cystic fibrosis (surgery) Down syndrome (diagnosis) evidence based medicine genetic screening hormone substitution human intestine cancer (diagnosis) long term care lung transplantation mammography menopausal syndrome (drug therapy) meta analysis oncogene ovary cancer (diagnosis) patient preference patient referral prenatal diagnosis priority journal prostate cancer (diagnosis) review statistical analysis systematic review uterus myoma visual analog scale CAS REGISTRY NUMBERS progesterone (57-83-0) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Gastroenterology (48) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160319007 MEDLINE PMID 26549169 (http://www.ncbi.nlm.nih.gov/pubmed/26549169) PUI L610051850 DOI 10.1016/j.pec.2015.10.026 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2015.10.026 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 65 TITLE Knowledge and values for cancer screening decisions: Results from a national survey AUTHOR NAMES Hoffman R.M. Elmore J.G. Pignone M.P. Gerstein B.S. Levin C.A. Fairfield K.M. AUTHOR ADDRESSES (Hoffman R.M.) Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, United States. (Hoffman R.M.) Medicine Service, Iowa City VA Medical Center, Iowa City, United States. (Elmore J.G.) Department of Medicine, University of Washington School of Medicine, Seattle, United States. (Pignone M.P.) University of North Carolina Division of General Internal Medicine, Chapel Hill, United States. (Pignone M.P.) University of North Carolina Institute for Healthcare Quality Improvement, Chapel Hill, United States. (Gerstein B.S.; Levin C.A.) Informed Medical Decisions Foundation, Division of Healthwise, Inc., Boston, United States. (Fairfield K.M., fairfk@mmc.org) Department of Medicine and Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, United States. CORRESPONDENCE ADDRESS K.M. Fairfield, Department of Medicine and Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, United States. Email: fairfk@mmc.org SOURCE Patient Education and Counseling (2016) 99:4 (624-630). Date of Publication: 1 Apr 2016 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Background: Guidelines recommend shared decision making (SDM) for cancer screening decisions. SDM requires providers to ensure that patients are informed about screening issues and to support decisions that are concordant with patient values. We evaluated decision-quality factors for breast, colorectal, and prostate cancer screening decisions. Methods: We conducted a national, population-based Internet survey of adults aged 40+ to characterize perceptions about about cancer screening, the importance of information sources, cancer screening knowledge, values and preferences for screening, and the most influential drivers of decisions. Results: Among 1452 participants who completed the survey, the mean age was 60, and 94% were insured. Most participants reported feeling well informed about cancer screening, though only 21% reported feeling extremely well informed. Most participants correctly answered about 50% of the knowledge questions, with the majority markedly overestimating lifetime risk of cancer diagnoses and mortality. Participants rated health care providers as the most important source of information. Conclusion: Although respondents considered themselves well informed about cancer they performed poorly on knowledge questions. This discordance suggests the potential for poor-quality decision making. Practice implications: To improve the quality of decision making, providers need training to utilize decision support tools and time to carry out SDM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health cancer screening patient decision making EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (diagnosis) cancer diagnosis cancer mortality colorectal cancer (diagnosis) decision support system female health care personnel health survey human Internet knowledge lifespan male medical information priority journal prostate cancer (diagnosis) risk assessment EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015522588 MEDLINE PMID 26603446 (http://www.ncbi.nlm.nih.gov/pubmed/26603446) PUI L606964727 DOI 10.1016/j.pec.2015.11.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2015.11.001 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 66 TITLE Adjuvant endocrine therapy for breast cancer: Giving postmenopausal women a voice AUTHOR NAMES Vandezande L. Reymen M. Raeymaekers B. Heedfeld I. Biebuyck D. Christiaens M.R. Neven P. AUTHOR ADDRESSES (Vandezande L.; Reymen M.; Raeymaekers B.; Biebuyck D.) UZ Leuven, Department of Public Health and Primary Care, University Hospitals Nursing Center of Excellence, Leuven, Belgium. (Heedfeld I.) Jessa Hospital, Departement of Pneumology, Hasselt, Belgium. (Christiaens M.R.) UZ Leuven, Department of Oncology, University Hospitals Multidisciplinary Breast Center, Leuven, Belgium. (Neven P.) UZ Leuven, Department of Gynecology, University Hospitals Multidisciplinary Breast Center, Leuven, Belgium. CORRESPONDENCE ADDRESS L. Vandezande, UZ Leuven, Department of Public Health and Primary Care, University Hospitals Nursing Center of Excellence, Leuven, Belgium. SOURCE European Journal of Cancer (2016) 57 SUPPL. 2 (S30). Date of Publication: April 2016 CONFERENCE NAME 10th European Breast Cancer Conference, EBCC-10 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2016-03-09 to 2016-03-11 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Breast cancer is the most common cancer in women. In Europe, 75% of patients are postmenopausal at the time of diagnosis. Of these postmenopausal women (PMW), 80-85% has an hormone-sensitive (ER+) tumor. Adjuvant endocrine therapy (AET) significantly reduces the risk of recurrence. However, this treatment induces many side-effects which lead to low adherence rates. Therefore, research on women's experiences and restraints continuing AET is of great importance. Materials and Methods: First, in-depth interviews with PMW treated in the University Hospital of Leuven (UZ Leuven) were performed to explore their experiences and needs. Next, focus groups of the target group and their partners were completed to further develop a strategy to meet the informational and supportive needs. Permission of the Ethical Committee was obtained. Results: We started with 10 in-depth interviews followed by 4 focus groups with a total of 18 PMW and 1 focus group with 4 partners of PMW. Although PMW have individual needs that are influenced by patientrelated factors, 2 common themes arose. PMW need information on and counseling for their AET. Throughout the interviews PMW stipulate the perceived lack of information on working mechanism, benefits and (management of) side-effects. Furthermore, women need support in selfmanagement considering AET, preferably by a nurse. The participants of the focus groups further focused on a patient decision aid (PDA) and an information session developed with the data received from the interviews. They clearly pointed out the importance of this tool becoming an equal partner in medical decision making on AET. Moreover, PMW indicate additional important themes in the focus groups. PMW experience that their environment is unfamiliar with AET and thereby do not acknowledge the consequences and impairments of AET on patients daily living. Analyzing the data, also led to the conclusion that usually a rather paternalistic communication model is handled in their treatment. Patients seek to be more involved in decision making, so they can learn more about their own illness. Finally, PMW feel that their side-effects are not taken seriously enough by healthcare workers. Therefore, they feel isolated during this therapy. Saturation of data was not obtained within this sample. Conclusions: Women need more information on all aspects of AET and want nurse-led counseling to better manage their side-effects. They stipulate that the UZ Leuven PDA in combination with information sessions and individual counseling by their track companion will be beneficial in the care for PMW. In further research our PDA needs to be reviewed by a panel of experts and the efficacy must be investigated. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) adjuvant EMTREE DRUG INDEX TERMS aminoethylisothiouronium hormone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer European female hormonal therapy human postmenopause voice EMTREE MEDICAL INDEX TERMS counseling decision making diagnosis diseases environment Europe health care personnel information processing interpersonal communication interview medical decision making model neoplasm nurse patient risk side effect therapy university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72220565 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 67 TITLE Evidence-based peer support for newly diagnosed breast cancer patients AUTHOR NAMES Ludman E. Yeung L. Jones S. Palazzo L. King D. AUTHOR ADDRESSES (Ludman E.; Jones S.; Palazzo L.; King D.) Group Health Research Institute, Seattle, United States. (Yeung L.) Group Health Cooperative, Seattle, United States. CORRESPONDENCE ADDRESS E. Ludman, Group Health Research Institute, Seattle, United States. SOURCE Psycho-Oncology (2016) 25 SUPPL. 2 (112-113). Date of Publication: March 2016 CONFERENCE NAME 13th Annual Conference of the American Psychosocial Oncology Society, APOS 2016 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2016-03-03 to 2016-03-05 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT PURPOSE: Oncology clinics outside comprehensive cancer centers rarely have resources to support evidencebased psychosocial programs for newly diagnosed cancer patients. Led by a surgeon and a psychologist, a multi-disciplinary team including breast cancer survivors designed and evaluated a low cost education and peer support program for women with breast cancer in a community healthcare setting based on recommendations from the scientific literature. METHODS: The program was based on scientific literature about peer-based programs for people with cancer and/or chronic conditions and data from two focus groups with breast cancer survivors and advocates. We conducted an 18-month pilot of the monthly group program in a healthcare system in the Pacific Northwest. Meetings combined educational presentations by volunteer community experts (e.g., researchers, healthcare providers) with facilitated peer-support focused on self-care, problem-solving, goal-setting and peer mentoring of newly diagnosed patients. We used a mixed method approach combining qualitative data from patient and project team member interviews and funder progress reports to evaluate the program. RESULTS: 35 women of diverse cancer characteristics, age, race and ethnicity participated. The program was viewed as a valuable source of education, knowledge sharing and reciprocal help by patients. Participants were grateful for the opportunity to voice their experience and receive emotional and decision- making support and practical solutions from other patients. An unexpected benefit was a recurring opportunity for women to “show and tell” about their breast surgeries and reconstructions. Participants took initiative in creating a social media site for the group and identifying potential guest speakers. The peer-led program required relatively few resources and did not adversely affect clinical operations. CONCLUSIONS: After an initial investment of time, the peer support program was a low-cost means of enhancing diverse breast cancer patients' psychosocial health and satisfaction with their cancer care. The program may be a sustainable and disseminable model for other health care delivery environments. Research Implications: This program incorporated scientific findings about effective and ineffective elements of peer-led programs and was well-accepted in this pilot. Further research (i.e. a randomized controlled pragmatic trial) will be needed to evaluate the program's impact on important patient-reported and health service outcomes. Clinical Implications: Findings from the pilot evaluation suggest that a low cost peer-led program is feasible to implement, highly valued by participants, and increases patient satisfaction with care. Participant reports suggest that for some attendees the program increased satisfaction with the outcome of breast reconstruction by helping to manage expectations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast cancer cancer patient evidence based practice human oncology peer group society EMTREE MEDICAL INDEX TERMS breast reconstruction breast surgery cancer center cancer survivor community decision making education environment ethnicity female health health care health care delivery health care personnel health care system health service hospital information processing interview investment model neoplasm patient patient satisfaction problem solving program impact psychologist satisfaction scientific literature scientist self care social media surgeon voice volunteer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72278217 DOI 10.1002/pon.4082 FULL TEXT LINK http://dx.doi.org/10.1002/pon.4082 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 68 TITLE Racial and socioeconomic differences in control over breast cancer prevention decisions among women at elevated risk AUTHOR NAMES Padamsee T.J. Wills C. Paskett E. AUTHOR ADDRESSES (Padamsee T.J.; Wills C.; Paskett E.) CORRESPONDENCE ADDRESS T.J. Padamsee, SOURCE Cancer Epidemiology Biomarkers and Prevention (2016) 25:3 Supplement. Date of Publication: 1 Mar 2016 CONFERENCE NAME 8th AACR Conference on the Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved CONFERENCE LOCATION Atlanta, GA, United States CONFERENCE DATE 2015-11-13 to 2015-11-16 ISSN 1055-9965 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Currently, few high-risk women utilize biomedical methods that have been designed to prevent breast cancer, and there is a considerable mismatch between who chooses to use these methods and the research-based indications for clinical use. This research seeks to shed light on the reasons for these trends by understanding women's decision-making processes from their own perspectives. Specifically, this in-depth qualitative study aims to identify key challenges faced by women at elevated risk of breast cancer during the process of making decisions about whether they will undergo prophylactic mastectomies, prophylactic oophorectomies, chemoprevention, enhanced surveillance, and/or participate in other prevention activities. Methods: Semi-structured interviews are being conducted with African American and non-Hispanic White women at elevated risk of breast cancer. Eight pilot interviews were conducted in the Spring of 2015, and preliminary results based on these interviews are summarized below. Interviews are ongoing, and the presentation will draw on data from a larger set of thirty women, half African American and half White. Allowing women to speak in their own words, these interviews explore women's understanding of their risk status; the sources and content of risk information they have obtained; their understanding and consideration of prevention options; decision-making processes; decision-making networks, psychosocial well-being; and women's use of financial, time, and energy resources in coping with risk and prevention. Pilot interviews have ranged in length from 48 to 140 minutes and were professionally transcribed. Transcribed data are being analyzed through grounded theory methods, using the NVivo 10 software package for qualitative data. Results: Analysis of pilot data suggests that the desire to take control of one's health plays a significant role in women's decision-making processes. Almost all interviewees are strongly motivated to take control of their breast cancer risk in one way or another, often through substantial information gathering efforts, seeking support for prevention decision making, and actively choosing specific and definitive preventive actions. Taking control in these ways helps women keep risk-related anxiety at bay, and produces positive feelings about their health. Women also commonly experience challenges to their attempts to take control of breast cancer risk, in forms such as physician resistance or spousal opposition to certain courses of preventive action, or lack of insurance coverage for specific interventions. These difficulties are more common among African American and low-income women, who are more likely to lack insurance coverage for a test or procedure; less likely to be able to pursue their chosen prevention activities without insurance coverage; and more likely to encounter physician resistance to their efforts to take control and their prevention choices. Conclusions: Women's efforts to take control of their cancer risk deserve careful attention; they represent a common facet of the decision-making experience that has been almost entirely omitted from the literature on breast cancer prevention among women at elevated risk. Pending confirmation, these findings suggest that supporting women's ability to act on their desire for control (for example, by educating relevant physician communities and influencing policy changes among insurance carriers) may be a critical route to improving women's prevention decision making. Importantly, these types of interventions may be particularly effective for low-income and African American women. Enhancing women's ability to actively control prevention decisions and courses of action may ultimately have important positive effects on their long-term physical and psychosocial outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer prevention EMTREE MEDICAL INDEX TERMS African American anxiety attention cancer risk chemoprophylaxis clinical article controlled study decision making DNA transcription doctor patient relation energy resource female grounded theory human insurance lowest income group normal human ovariectomy prophylactic mastectomy qualitative research semi structured interview software spring wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613276422 DOI 10.1158/1538-7755.DISP15-A47 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7755.DISP15-A47 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 69 TITLE Exploring novel dimensions of body experience after breast reconstruction AUTHOR NAMES Leunissen T. de Boer M. van der Hulst R. Slatman J. AUTHOR ADDRESSES (Leunissen T., T.C.Leunissen@umcutrecht.nl) Department of Vascular Surgery, University Medical Center Utrecht, P.O Box 85500, Utrecht, Netherlands. (de Boer M.; Slatman J.) Department of Health, Ethics and Society, Maastricht University, P.O Box 616, Maastricht, Netherlands. (van der Hulst R.) Department of Plastic Surgery, Maastricht University Medical Center, P.O Box 5800, Maastricht, Netherlands. CORRESPONDENCE ADDRESS T. Leunissen, Heidelberglaan 100, Utrecht, Netherlands. Email: T.C.Leunissen@umcutrecht.nl SOURCE JPRAS Open (2016) 7 (32-41). Date of Publication: 1 Mar 2016 ISSN 2352-5878 (electronic) BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Studies on the post-breast reconstruction period are primarily conducted with questionnaires, focussing on general outcome parameters such as cosmetic result, quality of life or satisfaction. However, to explore how women see, appreciate and behave towards their own bodies, a different research approach is required. In this study, we used an empirical phenomenological design to explore how women experience their body after breast reconstruction in everyday practice. Methods: A qualitative, descriptive phenomenological design was used. A total of 18 semi-structured in-depth interviews were conducted with women who had undergone implant-based breast reconstruction (IBBR, n = 5) and autologous breast reconstruction (ABR, n = 13). The interviews were tape-recorded, transcribed verbatim and subsequently coded and analysed using NVivo, a qualitative data analysis software program. Results: A framework of six interrelated themes was identified: (1) 'the cosmetic body, (2) the sensed and touched body, (3) the body in action, (4) the sexual body, (5) awareness and (6) sense of self'. We found that women who have undergone IBBR report relatively similar changes in body experiences on all six themes, whereas women who have undergone ABR report a broad variety in changed body experiences after the reconstruction. Conclusions: The six identified themes indicate that various dimensions of body experience are at play for women after undergoing breast reconstruction. Women with IBBR have more similar body experiences compared with women who have undergone ABR. This knowledge can be implemented in counselling before surgery and can support shared treatment decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) body image breast reconstruction postoperative period EMTREE MEDICAL INDEX TERMS adult article autologous breast reconstruction awareness descriptive research female human implant based breast reconstruction Netherlands phenomenology qualitative analysis self concept semi structured interview surgical technique EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160251830 PUI L609266728 DOI 10.1016/j.jpra.2015.10.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpra.2015.10.001 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 70 TITLE Consensus and disagreement between experts and community practitioners asked to make therapeutic recommendations for early breast cancer (EBC) AUTHOR NAMES Obholz K.L. Rosenthal K.M. O'Regan R.M. Swain S.M. Yardley D.A. Brady E.D. AUTHOR ADDRESSES (Obholz K.L.; Rosenthal K.M.; O'Regan R.M.; Swain S.M.; Yardley D.A.; Brady E.D.) Clinical Care Options, LLC, Reston, VA; University of Wisconsin School of Medicine and Public Health, Madison, WI; Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, DC; Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN CORRESPONDENCE ADDRESS K.L. Obholz, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Intro. Most patients with stage II BC will receive surgery along with systemic therapy, but no consensus exists among experts on optimal use of neoadjuvant vs adjuvant therapy in many cases. Furthermore, treatment guidelines list multiple reasonable regimens for EBC, but lack patient-specific recommendations. We have shown previously that online decision support tools can affect treatment decisions of community practitioners. In this study, we sought to determine areas of consensus and disagreement among expert faculty providing treatment recommendations for a 2015 decision support tool on EBC as well as those using the online tool Methods. An online decision support tool was developed with input from 5 experts on systemic therapy recommendations for 235 patient scenarios in EBC. Tool users were asked to enter specific patient criteria and their intended management for each case before displaying the 5 expert recommendations for the user-entered case. Users were asked to indicate if the expert recommendations changed their intended approach Results. At interim analysis, 406 individuals used this tool, with 674 patient scenarios entered. Among users reporting on the tool's clinical impact, 88% indicated expert recommendations either confirmed or changed their intended therapy. Expert recommendations in the tool showed areas of consensus and disagreement in treating patients with EBC. For example, expert recommendations varied in the choice of systemic therapy prior to surgery and when to continue directly to surgery before systemic treatment. Experts did agree on starting with surgery in patients with node-negative, T1a disease; however, only 30% of tool users agreed. Both experts and users agreed in recommending systemic neoadjuvant therapy for patients with HER2+, node-positive T2 disease. In patients with HER2+ EBC, experts always chose to include dual HER2-targeted therapy in neoadjuvant systemic therapy but only included trastuzumab in adjuvant regimens. However, only 51% of tool users selected dual HER2-targeted therapy as part of neoadjuvant therapy and 13% use dual HER2-targeted therapy in the adjuvant setting. Expert opinion varied on when to use adjuvant chemotherapy in patients with HR+, HER2- EBC, particularly for those with intermediate or unknown recurrence scores and no lymph node involvement. Detailed comparison of expert consensus and disagreement, analysis of practice pattern information from user responses, and perceived impact of the expert recommendations will be presented Conclusions. This EBC tool highlights specific clinical scenarios having either consensus or disagreement among experts and community practitioners. Education that includes online decision support tools may increase the number of clinicians making optimal treatment decisions for patients with EBC. (Table Presented). EMTREE DRUG INDEX TERMS adjuvant trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer community consensus human physician EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adjuvant therapy decision support system education lymph node patient surgery systemic therapy therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72248305 DOI 10.1158/1538-7445.SABCS15-P5-09-04 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P5-09-04 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 71 TITLE The 12-gene DCIS score assay: Impact on radiation treatment (XRT) recommendations and clinical utility AUTHOR NAMES Manders J.B. Kuerer H.M. Smith B.D. McCluskey C. Farrar W.B. Frazier T.G. Li L. Leonard C.E. Carter D.L. Chawla S. Medeiros L.E. Guenther J.M. Castellini L.E. Buchholz D.J. Mamounas E.P. Wapnir I.L. Horst K.C. Chagpar A. Evans S.B. Riker A.I. Vali F.S. Solin L.J. Jablon L. Recht A. Sharma R. Lu R. Sing A.P. Hwang E.S. White J. AUTHOR ADDRESSES (Manders J.B.; Kuerer H.M.; Smith B.D.; McCluskey C.; Farrar W.B.; Frazier T.G.; Li L.; Leonard C.E.; Carter D.L.; Chawla S.; Medeiros L.E.; Guenther J.M.; Castellini L.E.; Buchholz D.J.; Mamounas E.P.; Wapnir I.L.; Horst K.C.; Chagpar A.; Evans S.B.; Riker A.I.; Vali F.S.; Solin L.J.; Jablon L.; Recht A.; Sharma R.; Lu R.; Sing A.P.; Hwang E.S.; White J.) The Christ Hospital Health Network, Cincinnati, OH; University of Texas M.D. Anderson Cancer Center, Houston, TX; Ohio State University James Cancer Hospital, Columbus, OH; Bryn Mawr Hospital, Bryn Mawr, PA; Rocky Mountain Cancer Centers, Denver, CO; Rochester Regional Health System, Rochester, NY; Saint Elizabeth Medical Center, Inc., Edgewood, KY; UF Health Cancer Center at Orlando Health, Orlando, FL; Stanford University, Stanford Cancer Institute, Palo Alto, CA; Yale University, New Haven, CT; Advocate Christ Medical Center, Oak Lawn, IL; Albert Einstein Health Network, Philadelphia, PA; Beth Israel Deaconess Medical Center, Boston, MA; Genomic Health, Inc., Redwood City, CA; Duke University Medical Center, Durham, NC CORRESPONDENCE ADDRESS J.B. Manders, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: In the management of DCIS clinicians and patients (pts) must choose between the various options for breast conservation treatment based on an assessment of local recurrence (LR) risk. Traditional clinicopathologic (CP) factors such as age, size, grade, margin width or comedo necrosis, provide an average LR risk derived from clinical trials and population studies. The Oncotype DX® 12-gene assay for DCIS gives individual 10-yr LR risk estimates and has now been validated in two studies in a total of 893 pts. We report the 2nd study assessing the impact of the DCIS Score result on XRT recommendations. In addition, surveys assessing pt and physician confidence will provide insight into the overall clinical utility of the DCIS Score result. Baseline characteristics including the pre-assay LR risk and XRT recommendation are described here; final results on change in XRT recommendation from pre- to post-assay and distribution of the score across the CP factors will be presented Methods: 13 U.S. sites enrolled pts with DCIS from 3/2014-5/2015. Pts with LCIS but no DCIS, invasive BC, or planned mastectomy were excluded. Data were prospectively collected on CP factors, physician estimates of LR risk, DCIS score, and pre/post XRT recommendation. Each pt had a surgeon and radiation oncologist complete study surveys. Pt surveys were also administered pre/post assay for decision conflict and the STAIT anxiety survey. The LR risk estimates and XRT recommendations were analyzed for all physicians as well as by specialty. Descriptive statistics summarized study variables. 95% Clopper-Pearson Exact CIs were calculated for percent change in XRT recommendation. McNemar's test was used to determine if the proportion of pts had a significant change in XRT recommendation post assay. Paired t-tests were used to compare physician estimates of recurrence risk pre/post assay Results: Of the 121 pts enrolled, median age was 61y (34-83) and 80.2% were postmenopausal. Median size was 8mm and 40% were < 5mm; 22.3% were grade 1, 51.2% grade 2, and 26.4% grade 3. Comedo necrosis was noted in 55.4% and 19% had multiple foci. Median margin width was 3mm and 47.1% had margins 1-3mm. ER and PR by IHC were positive in 88.4% and 75.2% of pts. Among the 242 MD risk assessments, mean 10-yr LR risk was 14.8% (range 4-50%) for any LR; 14.2% for surgeons and 15.3% for radiation oncologists. The pre-assay XRT recommendation was 70.2%; 68.6% for surgeons and 71.9% for radiation oncologists Conclusions: The role of new molecular tools such as the DCIS Score assay that provide individual risk estimates for LR on treatment decisions is evolving. The DCIS pts enrolled in the study reveal inclusion of baseline features like higher nuclear grade (26%), comedo necrosis (55%) and margin width of 1-3mm (47%) that have historically been associated with XRT use. This represents a continued broadening of the assay use from the predominantly lower risk DCIS cohort in the 1st validation study (E5194). The impact on XRT decisions is critical to establishing the clinical utility of the assay. The decision impact analysis, differences in use of the assay among surgeons and radiation oncologists and the impact on overall confidence with the treatment decision will be presented. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assay breast cancer gene intraductal carcinoma radiotherapy EMTREE MEDICAL INDEX TERMS anxiety breast clinical trial (topic) comedo human mastectomy McNemar test necrosis patient physician population research radiation oncologist recurrence risk risk risk assessment statistics Student t test surgeon United States validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72248359 DOI 10.1158/1538-7445.SABCS15-P5-17-03 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P5-17-03 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 72 TITLE Clinical trials: “A holistic approach” AUTHOR NAMES Spears P.A. Devine P. Finestone S. Carbine N. AUTHOR ADDRESSES (Spears P.A.; Devine P.; Finestone S.; Carbine N.) Cancer Information and Support Network (CISN), Auburn, United States. CORRESPONDENCE ADDRESS P.A. Spears, Cancer Information and Support Network (CISN), Auburn, United States. SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Goal: New and improved treatments depend on the completion of successful clinical trials. Our goal is to impact all aspects of the clinical trial process to enhance accrual and outcomes 1) To provide patient focused feedback at the design phase of clinical trials 2) To increase health literacy about clinical trials at both the national and community level 3) To provide decision aids for individual trials 4) To provide patient focused staff communication trainings Strategy: CISN principals are currently working with the following groups National Clinical Trial Network Academic Medical Centers: UCSF and Mayo Industry: Genentech, Pfizer, Novartis, and Lilly Nonprofit Organizations: AACR, Faster Cures, Susan G. Komen, SOCRA CISN principals are working within the NCTN to accomplish strategies one and two. The goal is to branch out to more community venues in the future. A 2001 study by Lara et. al. reported that the consent process with its legalistic and confusing forms is itself a barrier to patient participation with 49% of eligible patients declining enrollment. We address these concerns by accomplishing strategies 3 and 4 above Action Taken CISN is introducing the medical community to an array of issues affecting patients considering participation in clinical trials. They are also developing patient-centered, study specific, educational materials included as part of the informed consent process. These interventions may enhance patient literacy, improve patient satisfaction and advance public trust in the research enterprise, leading to responsible increased accrual and retention. Additionally, CISN has worked as a contractor for several biotech companies to develop patient educational materials for several studies Work done at the Clinical Trial Summit documented that 67% of professionals consenting patients have less than 6 hours of psychosocial training. To address that issue, CISN developed a training program for those professionals who administer consent. Two PhD psychologists where brought onboard as consultants to assist in the development of the training. To date CISN has conducted many trainings for various groups and will soon submit grants to partner with other organizations to translate the materials into Spanish and work with patient navigators to further ensure proper training in all communities Outcome Interest in our methods and materials continues to grow. CISN was identified by Faster Cures as having “best practice” methods in the area of informed consent. We work closely with academic, government, other non-profits and industry researchers to help foster public awareness about the importance of medical research to daily life. CISN addresses these issues and presents various strategies that might be applied to NCI network group and industry trials so as to bridge the research gap, move research forward, and adopt the best course to serve the needs of the community, researchers and patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer clinical trial (topic) EMTREE MEDICAL INDEX TERMS clinical trial community consultation feedback system government health literacy human industry informed consent interpersonal communication Mayo (people) medical research non profit organization organization patient patient participation patient satisfaction profit psychologist reading scientist training university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72248317 DOI 10.1158/1538-7445.SABCS15-P5-10-02 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P5-10-02 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 73 TITLE Integrating whole exome sequencing data with RNAseq and quantitative proteomics to better inform clinical treatment decisions in patients with metastatic triple negative breast cancer AUTHOR NAMES Soon-Shiong P. Rabizadeh S. Benz S. Cecchi F. Hembrough T. Mahen E. Burton K. Song C. Senecal F. Schmechel S. Pritchard C. Dorschner M. Blau S. Blau A. AUTHOR ADDRESSES (Soon-Shiong P.; Rabizadeh S.; Benz S.; Cecchi F.; Hembrough T.; Mahen E.; Burton K.; Song C.; Senecal F.; Schmechel S.; Pritchard C.; Dorschner M.; Blau S.; Blau A.) NantOmics, Culver City, CA; NantOmics, Santa Cruz, CA; NantOmics, Rockville, MD; University of Washington, Seattle, WA CORRESPONDENCE ADDRESS P. Soon-Shiong, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: The use of next-generation sequencing has significantly advanced personalized medicine for patients (pts) with breast cancer. Despite this technological advancement, there remains the challenge of understanding how and if tumor heterogeneity can confound molecular analysis and treatment decisions. It has been shown that the expression of ER, PR, and HER2 can vary widely within different areas of the same tumor and between matched primary and metastatic lesions. The “Intensive Trial of OMics in Cancer”-001 (ITOMIC-001; NCT01957514) enrolls pts with metastatic TNBC who are platinum-naive and scheduled to receive cisplatin. Multiple biopsies of up to 7 metastatic sites are performed prior to cisplatin and repeated upon completion of cisplatin and following subsequent therapies. A subset of specimens is chosen for DNA sequencing, RNA sequencing, and quantitative proteomics. We explored the discordance of genomic and proteomic alterations for intrapatient and temporal heterogeneity in pts with TNBC, and the potential benefit of panomic analysis to better inform treatment decisions. Methods: Between 7 and 107 tumor samples/biopsy specimens were obtained from each pt from 1-23 different time points. Blood samples were collected for matched tumor-normal genomic analysis. DNA sequencing data were processed using Contraster; RNASeq data confirmed the presence of gene mutations and was used to identify mutational and transcript abundance. PARADIGM was used to determine associations between gene mutations and signaling pathways. Selected reaction monitoring-mass spectrometry (SRM-MS) was used for proteomics analysis. Results: Almost all pts had loss of TP53 (common in TNBC), and 5 pts had germline BRCA1/2 events, some exhibiting a signature of mutations corresponding to a mismatch repair defect in ≥1 pt. FGFR1/2/3 mutations/amplifications occurred in 5 pts. Three of 12 pts (25%) achieved partial responses after receiving treatments (post cisplatin) based on the molecular profile of their tumor: 1 pt with two FGFR2 activating mutations treated with ponatinib, 1 with a germline BRCA2 mutation treated with veliparib, and 1 with highly expressed Gpnmb treated with an antibody drug conjugate against Gpnmb. Tumor samples showed increased mutational and rearrangement burdens over time but shared mutational characteristics that were unique to each pt. Through the shared alterations across time points for 3 pts, it was possible to reconstruct the clonal history and heterogeneity of the tumors as various therapeutic approaches were attempted. Conclusions: Here we show in TNBC, intrapatient and temporal heterogeneity that may lead to a lack of response to identified targeted therapies. Tumor samples taken over time from the same pt become enriched for more complex genomic structures post therapy but share mutational characteristics, indicating the presence of recurrent tumor populations. This study enabled us to reconstruct the clonal history and heterogeneity of tumors across space (metastatic vs primary at t=0) and time, illustrating the need for comprehensive molecular analysis and combination/multi-targeted therapeutics for optimal treatment in TNBC. EMTREE DRUG INDEX TERMS antibody cisplatin DNA platinum ponatinib RNA veliparib EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer exome human patient proteomics triple negative breast cancer EMTREE MEDICAL INDEX TERMS biopsy blood sampling conjugate DNA sequence gene mutation mass spectrometry mismatch repair monitoring mutation neoplasm next generation sequencing personalized medicine population RNA sequence therapy tumor recurrence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72248420 DOI 10.1158/1538-7445.SABCS15-P6-05-08 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P6-05-08 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 74 TITLE Breast cancer patients' preferences for adjuvant radiotherapy post-lumpectomy: Whole breast irradiation versus partial breast irradiation-single institutional study AUTHOR NAMES Szumacher E.F. McGuffin M. Presutti R. Pignol I.P. Harth T. Mesci A. Feldman-Stewart D. Chow E. DiProspero L. Vesprini D. Rakovitch E. Lee J. Doherty M. Soliman H. Ackerman I. Cao X. Kiss A. AUTHOR ADDRESSES (Szumacher E.F.; McGuffin M.; Presutti R.; Pignol I.P.; Harth T.; Mesci A.; Feldman-Stewart D.; Chow E.; DiProspero L.; Vesprini D.; Rakovitch E.; Lee J.; Doherty M.; Soliman H.; Ackerman I.; Cao X.; Kiss A.) Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Sunybrook Health Sciances Centre, Toronto, ON, Canada; Division of Cancer Care and Epidemiology, QCRI, Kingston, ON, Canada CORRESPONDENCE ADDRESS E.F. Szumacher, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background The standard regimen of radiotherapy following lumpectomy consists of whole breast irradiation (WBI) to the entire breast including the lumpectomy cavity and all the surrounding normal breast tissue. Recently, there has been increased interest in partial breast irradiation (PBI) as an alternative to WBI. However, the preferences of patients with early breast cancer as to what type of radiotherapy regimen post lumpectomy they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI and to identify important factors for patients when making their treatment decision. Methods Based on our previous study of early stage breast cancer patient information needs, the relevant literature and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients with early breast cancer who were referred for adjuvant radiotherapy at the large academic cancer center were invited to participate. Women >40 years of age with a new histological diagnosis of ductal carcinoma in-situ or invasive breast carcinoma treated with breast conserving surgery showing clear margins for non-invasive and invasive disease and negative axillary nodes were eligible. Descriptive statistics were calculated for all variables of interest. Survey question responses were compared between those preferring WBI or PBI using chi-square analyses or Fisher's exact tests. Results Ninety /126 patients who were approached about this study completed the survey, 27(30%) preferred PBI and 55(62%) preferred WBI. Four patients (4%) required more information to choose between WBIvsPBI, and 3 patients (3%) had no preferences. From patients who choose WBI,32(58%)patients preferred hypofractionated RTvs 14 (25%)conventional RTregimen, Factors rated as important by patients in making their decision included convenience [PBI=18/26(69%), WBI=36/54(67%)], financial factors [PBI=14/26(53%), WBI=21/55(38%)], radiation dose to the breast [PBI=20/26(80%), WBI=46/55(83%)], invasiveness [PBI=18/26(69%), WBI=43/53(81%),, recurrence rate [PBI=26/26(100%), WBI=55/55(100%)], survival [PBI=26/26(100%), WBI=54/55(98%)], side effects PBI 21/26 (81%) WBI 47/55(85%) effectiveness [PBI=25/26(96%), WBI=54/54(100%)], standard method of treatment [PBI=16/26(61%), WBI=52/54(96%), p=0.001] and radiation dose to surrounding organs [PBI=23/26(88%), WBI=52/54(95%)]. Conclusions Our study shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. There is significant association between preference of treatment and importance of standard treatment. Patients preferring WBRT were more likely to consider standard treatment as more important than those preferring PBI.There was a marginally significant association between marital status and preference of radiotherapy(p=0.0773) and employment (p=0.0667).Those currently not employed were marginally more likely to prefer WBI than those currently employed. A detailed analysis of all decisional preferences between WBI and PBI will be presented at the meeting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast breast cancer cancer patient human irradiation partial mastectomy EMTREE MEDICAL INDEX TERMS breast carcinoma cancer center chi square test consensus employment female Fisher exact test histology intraductal carcinoma marriage patient patient information questionnaire radiation dose radiotherapy recurrence risk side effect single (marital status) statistics survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72248128 DOI 10.1158/1538-7445.SABCS15-P4-11-10 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P4-11-10 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 75 TITLE Financial concerns about participation in clinical trials among patients with cancer AUTHOR NAMES Wong Y.-N. Schluchter M.D. Albrecht T.L. Benson A.B. Buzaglo J. Collins M. Flamm A.L. Fleisher L. Katz M. Kinzy T.G. Liu T.M. Manne S. Margevicius S. Miller D.M. Miller S.M. Poole D. Raivitch S. Roach N. Ross E. Meropol N.J. AUTHOR ADDRESSES (Wong Y.-N., yu-ning.wong@fccc.edu; Collins M.; Miller S.M.; Raivitch S.; Ross E.) Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, United States. (Buzaglo J.) Cancer Support Community Research and Training Institute, United States. (Fleisher L.) Children's Hospital of Philadelphia, United States. (Poole D.) University of Pennsylvania, Philadelphia, United States. (Schluchter M.D.; Kinzy T.G.; Liu T.M.; Margevicius S.; Miller D.M.; Meropol N.J.) Case Comprehensive Cancer Center, Case Western Reserve University, United States. (Meropol N.J.) University Hospitals Case Medical Center, Seidman Cancer Center, United States. (Flamm A.L.) Cleveland Clinic Foundation, Cleveland, United States. (Albrecht T.L.) Karmanos Cancer Institute, Wayne State University, Detroit, United States. (Benson A.B.) Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, United States. (Katz M.) International Myeloma Foundation, North Hollywood, United States. (Manne S.) Cancer Institute of New Jersey, New Brunswick, United States. (Roach N.) Fight Colorectal Cancer, Alexandria, United States. CORRESPONDENCE ADDRESS Y.-N. Wong, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, United States. Email: yu-ning.wong@fccc.edu SOURCE Journal of Clinical Oncology (2016) 34:5 (479-487). Date of Publication: 10 Feb 2016 ISSN 1527-7755 (electronic) 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, jcoservice@asco.org ABSTRACT Purpose: The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials. Methods: Weconducted a secondary data analysis of a randomized trial of aWeb-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): "Howmuch of a burden on you is the cost of your medical care?," "I'mafraid that my health insurancewon't pay for a clinical trial," and "I'mworried that I wouldn't be able to afford the costs of treatment on a clinical trial." Results were summed, with higher scores indicating greater concerns.We usedmultiple linear regressions tomeasure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics. Results: One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P <.001 for all models). Conclusion: Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients' financial needs and concerns may reduce distress and improve patient decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) financial management malignant neoplasm (disease management) patient decision making EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (disease management) cancer patient colorectal cancer (disease management) decision support system employment status female health care cost health education human lung cancer (disease management) major clinical study male pancreas cancer (disease management) priority journal race randomized controlled trial (topic) secondary analysis self report EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160155906 MEDLINE PMID 26700120 (http://www.ncbi.nlm.nih.gov/pubmed/26700120) PUI L608391715 DOI 10.1200/JCO.2015.63.2463 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2015.63.2463 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 76 TITLE Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review AUTHOR NAMES Recio-Saucedo A. Gerty S. Foster C. Eccles D. Cutress R.I. AUTHOR ADDRESSES (Recio-Saucedo A., A.Recio-Saucedo@soton.ac.uk; Foster C.) University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom. (Gerty S.; Eccles D.; Cutress R.I.) Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton, United Kingdom. CORRESPONDENCE ADDRESS A. Recio-Saucedo, Health Sciences, University of Southampton, , United Kingdom. Email: A.Recio-Saucedo@soton.ac.uk SOURCE Breast (2016) 25 (1-13). Date of Publication: 1 Feb 2016 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Objectives: Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. Methods: Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. Results: Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. Conclusion: Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) information mastectomy partial mastectomy patient preference EMTREE MEDICAL INDEX TERMS age body image cancer risk career family human patient decision making patient participation priority journal review second cancer sexuality side effect systematic review EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160166787 MEDLINE PMID 26801410 (http://www.ncbi.nlm.nih.gov/pubmed/26801410) PUI L608648269 DOI 10.1016/j.breast.2015.11.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2015.11.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 77 TITLE Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective AUTHOR NAMES Mortimer J.W. McLachlan C.S. Hansen C.J. Assareh H. Last A. McKay M.J. Shakespeare T.P. AUTHOR ADDRESSES (Mortimer J.W., josh.mortimer@student.unsw.edu.au; Shakespeare T.P.) Rural Clinical School, Faculty of Medicine, University of New South Wales, Coffs Harbour, Australia. (McLachlan C.S.; Assareh H.) Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia. (Hansen C.J.; Last A.) Department of Radiation Oncology, North Coast Cancer Institute, Port Macquarie, Australia. (Assareh H.) Epidemiology, Executive Medical Services, Western Sydney Local Health District, Sydney, Australia. (McKay M.J.) Department of Radiation Oncology, North Coast Cancer Institute, Lismore, Australia. (Shakespeare T.P.) Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour, Australia. CORRESPONDENCE ADDRESS J.W. Mortimer, UNSW Rural Clinical School, Coffs Harbour Health Campus, 345 Pacific Highway, Coffs Harbour, Australia. Email: josh.mortimer@student.unsw.edu.au SOURCE Journal of Medical Imaging and Radiation Oncology (2016) 60:1 (146-153). Date of Publication: 1 Feb 2016 ISSN 1754-9485 (electronic) 1754-9477 BOOK PUBLISHER Blackwell Publishing, info@asia.blackpublishing.com.au ABSTRACT Introduction The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Methods Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Results Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Conclusions Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer radiotherapy health care cost hypofractionated radiotherapy mastectomy EMTREE MEDICAL INDEX TERMS article Australia Australian breast cancer (diagnosis, radiotherapy, therapy) cancer patient cohort analysis controlled study human intensity modulated radiation therapy lymph node major clinical study medical record medicare practice guideline priority journal rank sum test retrospective study Student t test EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151015147 MEDLINE PMID 26511607 (http://www.ncbi.nlm.nih.gov/pubmed/26511607) PUI L607202329 DOI 10.1111/1754-9485.12405 FULL TEXT LINK http://dx.doi.org/10.1111/1754-9485.12405 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 78 TITLE Evaluation of option grids to support shared decision-making in breast cancer treatment AUTHOR NAMES Hahlweg P. Witzel I. Müller V. Elwyn G. Durand M.-A. Härter M. Scholl I. AUTHOR ADDRESSES (Hahlweg P.; Härter M.; Scholl I.) Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg, Germany. (Witzel I.; Müller V.) Universitätsklinikum Hamburg-Eppendorf, Klinik für Gynäkologie, Hamburg, Germany. (Elwyn G.; Durand M.-A.) Dartmouth College, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, United States. CORRESPONDENCE ADDRESS P. Hahlweg, Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie, Hamburg, Germany. SOURCE Oncology Research and Treatment (2016) 39 SUPPL. 1 (46). Date of Publication: February 2016 CONFERENCE NAME 32. Deutscher Krebskongress, DKK 2016 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2016-02-24 to 2016-02-27 ISSN 2296-5270 BOOK PUBLISHER S. Karger AG ABSTRACT Background: Shared decision-making (SDM) is important in oncology, where many preference-sensitive treatment options exist. Many cancer patients wish active engagement in treatment decision-making. Despite evidence, SDM is not widely implemented in routine practice. Option Grids are short decision aids that help patients and physicians to compare treatment options. So far Option Grids are not available in German. The aims of this study are to translate and adapt two Grids on breast cancer treatment, to evaluate their acceptance and feasibility in routine care, and to assess needs for further Grids. Method: We have designed a two-phased study: 1) Translation of both Option Grids into German, comparison to German clinical standards, testing of patients' understanding via cognitive interviews. 2) Pilot testing including focus groups with patients and clinicians to assess acceptability, followed by real world testing in routine breast cancer care using participant observation. Results: First results show that physicians and patients valued the idea of Option Grids. However, several cycles of adaptation were found to be necessary in order to reach adequate acceptance. In addition, the feasibility of using Option Grids in Germany was questioned by several physicians. They expressed doubt if Option Grids can be used in current health care structures and if the options in the translated Option Grids are relevant in Germany. Final results, including pilot testing data, will be presented during the conference. Discussion: This study provided a German version of two Option Grids for breast cancer treatment to be used in Germany for the first time as well as an assessment of their acceptability and feasibility in routine clinical settings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer therapy decision making EMTREE MEDICAL INDEX TERMS adaptation cancer patient German (citizen) Germany health care organization human information processing interview oncology participant observation patient physician LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72212436 DOI 10.1159/000444354 FULL TEXT LINK http://dx.doi.org/10.1159/000444354 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 79 TITLE Analysis of prognostication and treatment benefit tools for women with early breast cancer as a prerequisite for informed shared decision making AUTHOR NAMES Mühlbauer V. Mühlhauser I. Steckelberg A. AUTHOR ADDRESSES (Mühlbauer V.; Mühlhauser I.; Steckelberg A.) Universität Hamburg, MIN-Fakultät, Gesundheitswissenschaften, Hamburg, Germany. CORRESPONDENCE ADDRESS V. Mühlbauer, Universität Hamburg, MIN-Fakultät, Gesundheitswissenschaften, Hamburg, Germany. SOURCE Oncology Research and Treatment (2016) 39 SUPPL. 1 (49). Date of Publication: February 2016 CONFERENCE NAME 32. Deutscher Krebskongress, DKK 2016 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2016-02-24 to 2016-02-27 ISSN 2296-5270 BOOK PUBLISHER S. Karger AG ABSTRACT Background: Shared decision making (SDM) is strongly recommended in the German treatment guideline for breast cancer. Following evidence-based criteria informed SDM requires decision aids that are based on individualized risk information rather than mere cancer prognosis such as 5-year relative survival. Treatment decisions should be based on individual prognostic data that include comorbidities and age-dependent risk of death from causes other than breast cancer. Methods: Systematic literature search in Pubmed and EMBASE and free internet search. Prognostication tools for women with early, ER-positive breast cancer were analyzed for incorporated variables, information on the prognosis without adjuvant therapy, underlying data base, model validation and being up-to-date. Results: We identified 3 relevant prognostication tools on survival: Adjuvant!, PREDICT and CancerMath. All tools consider age and tumor characteristics; 2 tools differentiate between cancer death and death from other causes but use US data and are outdated. Adjuvant! has shown to improve SDM and to change treatment decisions in a randomized controlled trial. Limitations of the identified tools include lack of variables as comorbidity, Her2 status or mode of cancer detection. No tools using German data could be identified; PREDICT uses European data. Conclusion: All tools have relevant limitations. A prognostication tool for individualized risk communication is not available for women with early breast cancer in Germany but is urgently needed. Otherwise informed shared decision making as recommended in guidelines cannot be realized. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision making female human EMTREE MEDICAL INDEX TERMS adjuvant therapy cancer diagnosis cancer mortality cancer prognosis comorbidity data base death European evidence based practice German (citizen) Germany Internet interpersonal communication Medline model neoplasm prognosis randomized controlled trial randomized controlled trial (topic) risk survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72212444 DOI 10.1159/000444354 FULL TEXT LINK http://dx.doi.org/10.1159/000444354 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 80 TITLE Risk Model-Guided Antiemetic Prophylaxis vs Physician's Choice in Patients Receiving Chemotherapy for Early-Stage Breast Cancer: A Randomized Clinical Trial AUTHOR NAMES Clemons M. Bouganim N. Smith S. Mazzarello S. Vandermeer L. Segal R. Dent S. Gertler S. Song X. Wheatley-Price P. Dranitsaris G. AUTHOR ADDRESSES (Clemons M.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada2Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Bouganim N.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Smith S.) Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Mazzarello S.) Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Vandermeer L.) Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Segal R.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Dent S.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Gertler S.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Song X.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Wheatley-Price P.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada (Dranitsaris G.) Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada SOURCE JAMA oncology (2016) 2:2 (225-231). Date of Publication: 1 Feb 2016 ISSN 2374-2445 (electronic) ABSTRACT IMPORTANCE: Despite multiple patient-centered factors being associated with the risk of chemotherapy-induced nausea and vomiting (CINV), these factors are rarely considered when making antiemetic recommendations.OBJECTIVE: To compare risk model-guided (RMG) antiemetic prophylaxis with physician's choice (PC) in patients receiving chemotherapy for early-stage breast cancer.DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 324 patients with early-stage breast cancer undergoing chemotherapy (cyclophosphamide and an anthracycline) for the first time at 2 specialty cancer care centers in Ottawa from April 10, 2012, to September 2, 2014. Patients were randomized to either the RMG arm (n = 154) or the PC control arm (n = 170). Prior to each cycle of chemotherapy patients in the RMG group were categorized as low or high risk for CINV, and their antiemetic treatments were adjusted accordingly.INTERVENTIONS: Patients considered to be at low risk received standard dexamethasone and a 5-HT3 antagonist, while those at high risk also received aprepitant with or without olanzapine, based on their risk level. The PC control group received antiemetic agents according to the treating physician's discretion.MAIN OUTCOMES AND MEASURES: The primary end points were control of both nausea and vomiting in the acute posttreatment period (first 24 hours after therapy) and in the delayed posttreatment period (days 2-5 after therapy).RESULTS: The total numbers of chemotherapy cycles delivered in the RMG and PC control groups were 497 and 551 respectively. In the acute period, significantly more patients in the RMG group reported no nausea (53.7% [95% CI, 49.2%-58.1%] vs 41.6% [95% CI, 37.4%-45.3%]; P < .001) and no vomiting (91.8% [95% CI, 89.0%-94.0%] vs 82.2% [95% CI, 78.8%-85.3%]; P < .001) compared with the PC control group. Similarly, significantly more patients in the RMG group reported no nausea (39.6% [95% CI, 35.3%-44.1%] vs 30.7% [95% CI, 26.8%-34.7%]; P = .01) and no vomiting (87.1% [95% CI, 83.8%-90.0%) vs 78.0% [95% CI, 74.3%-81.4%]; P <  .001) in the delayed period respectively.CONCLUSIONS AND RELEVANCE: In this trial, the RMG antiemetic prophylaxis led to improved control of acute and delayed CINV compared with physician's choice of therapy.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01913990. EMTREE DRUG INDEX TERMS anthracycline (adverse drug reaction) antiemetic agent (drug administration, adverse drug reaction) antineoplastic agent (adverse drug reaction) benzodiazepine derivative (drug administration) cyclophosphamide (adverse drug reaction) dexamethasone (drug administration) olanzapine ondansetron (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice decision support system EMTREE MEDICAL INDEX TERMS adult aged breast tumor (drug therapy) cancer staging chemically induced clinical trial comparative study controlled study decision making drug administration female human middle aged multicenter study nausea (prevention) Ontario pathology patient selection predictive value randomized controlled trial risk assessment risk factor time factor treatment outcome vomiting (prevention) CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) dexamethasone (50-02-2) olanzapine (132539-06-1) ondansetron (103639-04-9, 116002-70-1, 99614-01-4) CLINICAL TRIAL NUMBERS LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26562292 (http://www.ncbi.nlm.nih.gov/pubmed/26562292) PUI L611035343 DOI 10.1001/jamaoncol.2015.3730 FULL TEXT LINK http://dx.doi.org/10.1001/jamaoncol.2015.3730 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 81 TITLE Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management AUTHOR NAMES Samuel C.A. Turner K. Donovan H.A.S. Van Londen G.J. AUTHOR ADDRESSES (Samuel C.A.; Turner K.; Donovan H.A.S.; Van Londen G.J.) The University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Pittsburgh School of Nursing, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA CORRESPONDENCE ADDRESS C.A. Samuel, SOURCE Journal of Clinical Oncology (2016) 34:3 SUPPL. 1. Date of Publication: 20 Jan 2016 CONFERENCE NAME 2016 Cancer Survivorship Symposium: Advancing Care and Research CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2016-01-15 to 2016-01-16 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) typically involves a multidisciplinary team of health care providers; yet few studies have examined provider perspectives on AET-related SM. The purpose of this study was to examine provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM and its barriers and facilitators as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described patient-, provider-, and system- level facilitators and barriers to AET-related SM. At the patient-level, facilitators included social support and provider communication about symptoms while cancer-related distress, misinformation and misinterpretation of online information were identified as barriers. Provider-level facilitators included strong relationships with other providers and ongoing communication with patients; however, lack of time, insufficient resources, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Finally, at the system-level, electronic health records were described as both a facilitator and barrier to SM. Moreover, poor care coordination among different providers and lack of clear guidelines on which provider “owns” AET-related SM emerged as key system-level barriers. Conclusions: Findings suggest that efforts to improve AET-related SM should span multiple levels, in order to address patient-, provider-, and system-level barriers to SM. Recommendations include increased education for patients, greater access to clinical decision support tools for providers, and improved coordination of survivorship resources within hospitals. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) adjuvant EMTREE DRUG INDEX TERMS aminoethylisothiouronium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hormonal therapy neoplasm EMTREE MEDICAL INDEX TERMS breast cancer cancer survivor decision support system education electronic medical record health care personnel hospital human information processing interpersonal communication patient physician social support software university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72232180 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 82 TITLE Anticipated regret in shared decisionmaking: A randomized experimental study AUTHOR NAMES Speck R.M. Neuman M.D. Resnick K.S. Mellers B.A. Fleisher L.A. AUTHOR ADDRESSES (Speck R.M.) Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, United States. (Speck R.M.) Evidera, 1417 4th Ave., Suite 510, Seattle, United States. (Neuman M.D.) Department of Anesthesiology and Critical Care, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, United States. (Resnick K.S.) Department of Psychiatry, University of Pennsylvania, 3535 Market St, Philadelphia, United States. (Mellers B.A.) Department of Psychology, Department of Marketing, University of Pennsylvania, 3720 Walnut St, Philadelphia, United States. (Fleisher L.A., lee.fleisher@uphs.upenn.edu) Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, United States. CORRESPONDENCE ADDRESS L.A. Fleisher, Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, United States. Email: lee.fleisher@uphs.upenn.edu SOURCE Perioperative Medicine (2016) 5:1 Article Number: 5. Date of Publication: 2016 ISSN 2047-0525 (electronic) BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Background: Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examined whether regret is a consideration in treatment decisions. Methods: In this randomized experimental study, 184 healthy female volunteers were randomized to receive a standard decision aid (control) or one with information on post-surgical regret (experimental). The main outcome measures were the proportion of subjects choosing lumpectomy vs. mastectomy and the proportion reporting that regret played a role in the decision made. We hypothesized that a greater proportion of the experimental group (regret-incorporated decision aid) would make a surgical treatment preference that favored the less regret-inducing option and that they would be more likely to consider regret in their decision-making process as compared to the control group. Results: A significantly greater proportion of the experimental group subjects reported regret played a role in their decision-making process compared to the control counterparts (78 vs. 65 %; p = 0.039). Recipients of the regretincorporated experimental decision aid had a threefold increased odds of choosing the less regret-inducing surgery (OR = 2.97; 95 % CI = 1.25, 7.09; p value = 0.014). Conclusions: In this hypothetical context, the incorporation of regret in a decision aid for preference-sensitive surgery impacted decision-making. This finding suggests that keying in on anticipated regret may be an important element of shared decision-making strategies. Our results make a strong argument for applying this design and pursuing further research in a surgical patient population. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS adult article controlled study female health survey human human experiment medical decision making normal human partial mastectomy pilot study priority journal quality of life randomized controlled trial young adult EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT02563808) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160854987 PUI L613211560 DOI 10.1186/s13741-016-0031-6 FULL TEXT LINK http://dx.doi.org/10.1186/s13741-016-0031-6 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 83 TITLE Outcomes of contralateral prophylactic mastectomy in relation to familial history: A decision analysis AUTHOR NAMES Davies K.R. Brewster A. Bedrosian I. Parker P. Crosby M.A. Peterson S.K. Shen Y. Volk R. Cantor S.B. AUTHOR ADDRESSES (Davies K.R.; Brewster A.; Bedrosian I.; Parker P.; Crosby M.A.; Peterson S.K.; Shen Y.; Volk R.; Cantor S.B.) CORRESPONDENCE ADDRESS K.R. Davies, SOURCE Cancer Research (2016) 76:14 Supplement. Date of Publication: 2016 CONFERENCE NAME 107th Annual Meeting of the American Association for Cancer Research, AACR 2016 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2016-04-16 to 2016-04-20 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Purpose Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival outcomes after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer in relation to degree of family history. Methods We created a microsimulation model for women with a first-degree, second-degree and no family history treated for a stage I, II, or III estrogen receptor (ER)positive or negative breast cancer at the ages of 40, 50, 60, and 70 years. The model incorporated a 10-year post-treatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate the quality-adjusted life expectancy for two clinical strategies: CPM and no CPM. Results CPM had a minimal improvement on quality-adjusted life expectancy among women age 50 to 60 with no or a unilateral first or second-degree family history (range -.06 to 0.31) and was unfavorable for the majority of women age 70 with stage III breast cancer regardless of degree of family history (range -.08 to -.02). Sensitivity analysis showed the highest predicted benefit of CPM with 95% risk reduction was 0.57 QALY for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer. Conclusion Women age 40 years with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For the majority of women, having a family history does not improve the minimal effect of CPM on quality-adjusted life expectancy. EMTREE DRUG INDEX TERMS BRCA1 protein endogenous compound estrogen receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) prophylactic mastectomy EMTREE MEDICAL INDEX TERMS adult case report controlled study disease carrier disease model estrogen receptor positive breast cancer family study female first-degree relative gene mutation human life expectancy middle aged primary tumor quality adjusted life year risk reduction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613608747 DOI 10.1158/1538-7445.AM2016-2574 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.AM2016-2574 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 84 TITLE The acceptability of PEGASUS: an intervention to facilitate shared decision-making with women contemplating breast reconstruction AUTHOR NAMES Harcourt D. Griffiths C. Baker E. Hansen E. White P. Clarke A. AUTHOR ADDRESSES (Harcourt D.; Griffiths C.) a Centre for Appearance Research , University of the West of England , Bristol , UK (Baker E.; Hansen E.; Clarke A.) b Department of Plastic and Reconstructive Surgery , Royal Free Hospital , London , UK (White P.) c Department of Engineering, Design and Mathematics , University of the West of England , Bristol , UK SOURCE Psychology, health & medicine (2016) 21:2 (248-253). Date of Publication: 2016 ISSN 1465-3966 (electronic) ABSTRACT Good practice guidelines recommend that women who undergo mastectomy are offered reconstructive surgery. However, many who choose this option report a degree of decisional regret and dissatisfaction because their pre-surgical expectations were not met. This paper reports an acceptability study of a new intervention (PEGASUS) that aims to support shared decision-making by eliciting women's pre-surgical expectations and setting patient-centred goals. Eighteen women contemplating breast reconstruction completed the PEGASUS intervention. Semi-structured interviews were conducted with 12 women and 3 health professionals to explore their experiences of using PEGASUS. Interview transcripts were subjected to a thematic analysis, and a content analysis was conducted on 79 goals that the 18 women identified. Feedback was extremely positive--women found that completing PEGASUS alongside a discussion with a specially trained health professional helped them prepare for the surgical consultation and increased their trust in their surgeon. Staff reported that PEGASUS facilitated patient-centred discussions and informed the decisions made about potential surgery. This preliminary study suggests that this novel intervention is acceptable to patients and health professionals alike. Further work is needed to evaluate its efficacy and then its effectiveness with a larger sample of women, and its potential use with other patient groups. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making procedures psychology EMTREE MEDICAL INDEX TERMS adult aged attitude to health breast reconstruction breast tumor (surgery) doctor patient relation feasibility study female human interpersonal communication mastectomy middle aged patient participation patient referral qualitative research trust LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26107523 (http://www.ncbi.nlm.nih.gov/pubmed/26107523) PUI L616539889 DOI 10.1080/13548506.2015.1051059 FULL TEXT LINK http://dx.doi.org/10.1080/13548506.2015.1051059 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 85 TITLE Potential costs of breast augmentation mammaplasty AUTHOR NAMES Schmitt W.P. Eichhorn M.G. Ford R.D. AUTHOR ADDRESSES (Schmitt W.P., William.schmitt@grmep.com; Eichhorn M.G.; Ford R.D.) Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners, Michigan State University, 221 Michigan St. NE, Grand Rapids, United States. CORRESPONDENCE ADDRESS W.P. Schmitt, Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners, Michigan State University, 221 Michigan St. NE, Grand Rapids, United States. Email: William.schmitt@grmep.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:1 (55-60). Date of Publication: 1 Jan 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Augmentation mammaplasty is one of the most common surgical procedures performed by plastic surgeons. The aim of this study was to estimate the cost of the initial procedure and its subsequent complications, as well as project the cost of Food and Drug Administration (FDA)-recommended surveillance imaging. Methods The potential costs to the individual patient and society were calculated. Local plastic surgeons provided billing data for the initial primary silicone augmentation and reoperative procedures. Complication rates used for the cost analysis were obtained from the Allergen Core study on silicone implants. Imaging surveillance costs were considered in the estimations. Results The average baseline initial cost of silicone augmentation mammaplasty was calculated at $6335. The average total cost of primary breast augmentation over the first decade for an individual patient, including complications requiring reoperation and other ancillary costs, was calculated at $8226. Each decade thereafter cost an additional $1891. Costs may exceed $15,000 over an averaged lifetime, and the recommended implant surveillance could cost an additional $33,750. Discussion The potential cost of a breast augmentation, which includes the costs of complications and imaging, is significantly higher than the initial cost of the procedure. Level of evidence Level III, economic and decision analysis study. EMTREE DRUG INDEX TERMS analgesic agent (pharmacoeconomics) silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation health care cost EMTREE MEDICAL INDEX TERMS anthropometric parameters breast asymmetry breast biopsy breast disease (complication, disease management, surgery) breast size breast tumor (complication, disease management, surgery) conference paper cost benefit analysis drug cost hematoma (complication, disease management, surgery) human implant capsular contracture (complication, disease management, surgery) malposition (complication, disease management, surgery) medical fee nuclear magnetic resonance imaging plastic surgeon postoperative complication (complication, disease management, surgery) postoperative infection (complication, disease management, surgery) priority journal ptosis (complication, disease management, surgery) reoperation scar formation (complication, disease management, surgery) seroma (complication, disease management, surgery) silicone prosthesis (adverse device effect) EMBASE CLASSIFICATIONS Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151056564 MEDLINE PMID 26601873 (http://www.ncbi.nlm.nih.gov/pubmed/26601873) PUI L607381401 DOI 10.1016/j.bjps.2015.09.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.09.012 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 86 TITLE Reoperation costs in attempted breast-conserving surgery: A decision analysis AUTHOR NAMES Pataky R.E. Baliski C.R. AUTHOR ADDRESSES (Pataky R.E.) Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, Canada. (Baliski C.R., cbaliski@bccancer.bc.ca) Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, Canada. (Baliski C.R., cbaliski@bccancer.bc.ca) Department of Surgery, University of British Columbia, Vancouver, Canada. CORRESPONDENCE ADDRESS C.R. Baliski, Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, 399 Royal Avenue, Kelowna, Canada. Email: cbaliski@bccancer.bc.ca SOURCE Current Oncology (2016) 23:5 (314-321). Date of Publication: 2016 ISSN 1718-7729 (electronic) 1198-0052 BOOK PUBLISHER Multimed Inc. ABSTRACT Background Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after bcs, and the effect that a reduction in the reoperation rate could have on the B.C. health care system. Methods A decision tree was constructed to estimate the average cost per patient undergoing initial bcs with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy. Results Costs ranged from a low of $8,225 per patient with definitive bcs [95% confidence interval (ci): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% ci: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted bcs (95% ci: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually. Summary The implementation of initiatives to reduce reoperation after bcs could result in significant savings to the health care system, while potentially improving the quality of patient care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery health care cost reoperation EMTREE MEDICAL INDEX TERMS article breast reconstruction hospital cost human mastectomy prosthesis implantation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160798250 PUI L613093186 DOI 10.3747/co.23.2989 FULL TEXT LINK http://dx.doi.org/10.3747/co.23.2989 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 87 TITLE Quality of Online Information to Support Patient Decision-Making in Breast Cancer Surgery Bruce JG, Tucholka JL, Steffens NM, et al (Univ of Wisconsin, Madison) J Surg Oncol 112:575-580, 2015 AUTHOR NAMES Cowher M.S. Witten M.O. AUTHOR ADDRESSES (Cowher M.S.; Witten M.O.) SOURCE Breast Diseases (2016) 27:2 (117-118). Date of Publication: 2016 ISSN 1878-1918 (electronic) 1043-321X BOOK PUBLISHER Academic Press Inc., apjcs@harcourt.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer surgery Internet medical information patient decision making patient information EMTREE MEDICAL INDEX TERMS human mastectomy note EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160434097 PUI L610733463 DOI 10.1016/j.breastdis.2016.04.023 FULL TEXT LINK http://dx.doi.org/10.1016/j.breastdis.2016.04.023 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 88 TITLE Adjuvant treatment for breast cancer AUTHOR NAMES Flatley M.J. Dodwell D.J. AUTHOR ADDRESSES (Flatley M.J.; Dodwell D.J.) St James's Institute of Oncology, Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom. SOURCE Surgery (United Kingdom) (2016) 34:1 (43-46). Date of Publication: 1 Jan 2016 ISSN 1878-1764 (electronic) 0263-9319 BOOK PUBLISHER Elsevier Ltd ABSTRACT Adjuvant treatment for breast cancer is given following primary surgical management and aims to reduce the risk of recurrence (both local and distant) as well as improve survival rates. Radiotherapy is delivered to reduce local recurrence risk. Whole breast radiotherapy is considered standard treatment following breast-conserving surgery for invasive cancer and is also considered after mastectomy depending on pathological risk factors. Systemic therapies (such as chemotherapy, endocrine treatment and biological therapy) reduce the risk of distant metastases and improve overall survival. The decision to advise adjuvant treatment is complex (taking into account both prognostic and patient factors) and is made with the patient following a multidisciplinary team meeting. It is now common practice to employ benefit-risk calculators in the clinical setting to aid treatment decision making. Recent major advances in both systemic treatments and radiotherapy techniques have led to more personalized treatment for patients with the aim to reduce breast cancer mortality even further. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) cancer adjuvant therapy EMTREE MEDICAL INDEX TERMS biological therapy cancer chemotherapy cancer hormone therapy cancer mortality cancer patient cancer prognosis cancer radiotherapy clinical decision making distant metastasis (complication) human mastectomy overall survival partial mastectomy personalized medicine premenopause priority journal recurrence risk review risk benefit analysis risk reduction survival rate systemic therapy tumor invasion EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160104112 PUI L608135296 DOI 10.1016/j.mpsur.2015.10.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpsur.2015.10.003 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 89 TITLE Celebrity Health Announcements and Online Health Information Seeking: An Analysis of Angelina Jolie's Preventative Health Decision AUTHOR NAMES Dean M. AUTHOR ADDRESSES (Dean M.) a Department of Communication , University of South Florida SOURCE Health communication (2016) 31:6 (752-761). Date of Publication: 2016 ISSN 1532-7027 (electronic) ABSTRACT On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie's decision. Qualitative content analysis revealed four main themes--information about genetics, information about a PBM, information about health care, and information about Jolie's gender identity. Broadly, the identified websites mention Jolie's high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie's health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie's health decision in positive, negative, and/or both ways. Discussion centers on how this actress' health decision impacts the public. EMTREE DRUG INDEX TERMS BRCA1 protein BRCA1 protein, human EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) information seeking public figure statistics and numerical data EMTREE MEDICAL INDEX TERMS attitude to health breast tumor (surgery) consumer health information decision making genetic predisposition genetic screening genetics human Internet interpersonal communication mastectomy procedures psychology risk assessment utilization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26574936 (http://www.ncbi.nlm.nih.gov/pubmed/26574936) PUI L614821665 DOI 10.1080/10410236.2014.995866 FULL TEXT LINK http://dx.doi.org/10.1080/10410236.2014.995866 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 90 TITLE Shining the light on developing patient centered radiation therapy education using a virtual learning environment AUTHOR NAMES Jimenez Y. Wang W. Stuart K. Latty D. Sharp W. Lewis S. AUTHOR ADDRESSES (Jimenez Y.; Lewis S.) University of Sydney, Faculty of Health Sciences, Australia. (Wang W.; Stuart K.; Latty D.; Sharp W.) Crown Princess Mary Cancer Centre, Westmead, Australia. CORRESPONDENCE ADDRESS Y. Jimenez, University of Sydney, Faculty of Health Sciences, Australia. SOURCE Journal of Medical Radiation Sciences (2016) 63 Supplement 1 (76). Date of Publication: 2016 CONFERENCE NAME 11th Annual Scientific Meeting of Medical Imaging and Radiation Therapy CONFERENCE LOCATION Brisbane, QLD, Australia CONFERENCE DATE 2016-04-22 to 2016-04-24 ISSN 2051-3909 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Objectives: Patient education in radiation therapy (RT) is often associated with the transfer of information which is unfamiliar and difficult for lay people to understand. Hence it is imperative that RT patient education programs are specifically developed for the target group and include salient visual aids. A patient education program which incorporates the Virtual Environment for Radiotherapy Training (VERT) system was developed as part of a pilot study for breast cancer patients. The focus of the presentation is on the methodology and development considerations of the VERT based patient education program. Methods: The development of the education program was undertaken in a multi-stage process involving clinical consultation and evidence based educational design, which included a review of virtual education effectiveness and identification of key features in the VERT system. In particular, strong consideration of patients as adult learners informed the development of the resource. Results: A 1 h RT breast cancer patient education program was developed and tailored to patients at the Crown Princess Mary Cancer Centre, Westmead Hospital. The VERT system is integral to the education program and serves as a focal education tool to visually demonstrate relevant simulation, planning and treatment aspects of RT. The content includes positioning, field arrangements and dose distribution, which is delivered in lay language. A virtual presenter, PowerPoint presentation and clinical immobilisation equipment supplement the program. Conclusion: Understanding the unique use of virtual and simulated learning methodologies for patients when developing education sessions in the radiation sciences is paramount to improving patient engagement. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) education program learning environment EMTREE MEDICAL INDEX TERMS adult breast cancer cancer center cancer patient clinical study consultation doctor patient relation female human identification key immobilization language patient education pilot study radiation dose distribution radiotherapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613470275 DOI 10.1002/jmrs.1_166/full FULL TEXT LINK http://dx.doi.org/10.1002/jmrs.1_166/full COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 91 TITLE The experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment: A qualitative systematic review AUTHOR NAMES Rittenmeyer L. Huffman D. Alagna M. Moore E. AUTHOR ADDRESSES (Rittenmeyer L., rittenme@purduecal.edu; Huffman D.; Alagna M.; Moore E.) The Indiana Center for Evidence Based Nursing Practice: a Collaborating Center of the Joanna Briggs Institute, Purdue University Calumet School of Nursing, United States. CORRESPONDENCE ADDRESS L. Rittenmeyer, The Indiana Center for Evidence Based Nursing Practice: a Collaborating Center of the Joanna Briggs Institute, Purdue University Calumet School of Nursing, United States. Email: rittenme@purduecal.edu SOURCE JBI Database of Systematic Reviews and Implementation Reports (2016) 14:2 (174-255). Date of Publication: 2016 ISSN 2202-4433 (electronic) BOOK PUBLISHER Joanna Briggs Institute, jbi@adelaide.edu.au ABSTRACT Background “Watchful waiting” or “active surveillance” is an alternative approach in the medical management of certain diseases. Most often considered appropriate as an approach to treatment for low-risk prostate cancer, it is also found in the literature in breast cancer surveillance, urinary lithiasis, lymphocytic leukemia, depression and small renal tumors. Objectives This systematic review sought to: Identify and synthesize the best available international evidence on the experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment. To this end the questions addressed in this review were: 1. How do patients who have chosen watchful waiting or active surveillance describe the process of coming to the decision? 2. What were the factors that influenced their decision to choose? 3. How do patients who have chosen watchful waiting or active surveillance describe the experience? Inclusion criteria Types of participants Male or female patients, 18 years or older, who experience the phenomenon of choosing or not choosing watchful waiting or active surveillance as a treatment approach. Phenomena of interest The phenomena of interest were accounts of the experiences of adult patients who choose watchful waiting or active surveillance as an approach to medical treatment. Types of studies This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and critical theory. Mixed method studies with narrative description and patient voice were also considered. Grey literature such as research reports and dissertations were also included. Search strategy The search strategy aimed to find both published and unpublished studies through electronic databases, reference lists, and the World Wide Web. Extensive searches were undertaken of relevant databases to include CINAHL, PubMed, SCOPUS and PsycINFO. A three-step search strategy was used in each component of the review. Studies were limited to English language papers. The search considered papers from the year 2000 to January 2015. Methodological quality Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data extraction Qualitative data were extracted from papers included in the review using the standardized data extraction tool from. The data extracted included specific details about the phenomena of interest that described the experiences pertinent to the review questions Data synthesis The data were synthesized using the Joanna Briggs Institute approach to meta-synthesis by meta-aggregation using the JBI-QARI software and methods. Results A total of 16 studies, critically appraised by two independent reviewers and deemed to be of high quality, were included in the final review. One study was excluded after appraisal. One hundred and fifty-five findings from the 16 studies were extracted into 10 categories and then into three synthesized findings. The synthesized findings explicated: 1. The complexity of making the decision 2. The fears that come with receiving a troubling diagnosis 3. The adaptations necessary to live with the decision. Conclusions The synthesized findings of the review conclude that the process of making the decision to choose watchful waiting is complex. Through the process patients and their significant others experience an array of emotions that often lead to uncertainty and anxiety. Once the decision is made patients must cope with the knowledge that they have a troubling diagnosis and make the necessary adjustments. An empathic, reassuring relationship with a healthcare practitioner eases the burden of this process. Implications for practice Healthcare providers need to recognize that not all patients are “at peace” with the decision of choosing watchful waiting. Uncertainty and fear may intensify during this time as well as feelings of stress and anxiety. Patients and their significant others often attempt to adapt in the best way they know how but the effectiveness of their coping strategies needs to be assessed. In addition, healthcare providers need to also be aware that with the increased anxiety and stress associated with watchful waiting, patients’ understanding of healthcare information and the ability to ask questions may be diminished. Both providers and patients benefit from open discussions related to the many aspects of uncertainty and fear related to making and living with the decision. Employing a shared decision making model with regard to the management of the array of issues that comes from both making the decision and living with it is recommended. It appears that patients are very sensitive to recognizing when the care they are receiving lacks empathy. Communication that is open, empathic, and non-judgmental is essential. A willingness to discuss sensitive issues such as sexual function needs to be conveyed. Lastly, providers and their staff need to remain attentive to the importance of articulating aspects of the situation that are hopeful and optimistic as many patients, during their visits, take their cues regarding their health status from non-verbal and verbal interactions. Implications for research Future studies should investigate: • Strategies that explore ways in which patients and families cope during watchful waiting and identify the most effective interventions for supporting adaptive strategies. • Types, sources and quality of information that patients access in order to aid them during their watchful waiting experience. • Perceptions of healthcare providers about the importance of addressing sexuality concerns with patients during watchful waiting. • Effectiveness of shared decision making and shared decision making aids implemented during watchful waiting. • The experience of being a spouse/life partner/significant other of a person living watchful waiting/active surveillance. • Sources of support that patients identify as most helpful during watchful waiting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health survey watchful waiting EMTREE MEDICAL INDEX TERMS adult anxiety breast cancer cancer epidemiology chronic lymphatic leukemia decision making disease course empathy gene mutation health care personnel health care system human life expectancy mammography multimodality cancer therapy orchiectomy patient assessment patient information physician prostate cancer prostatectomy radiotherapy review sexual function sexuality systematic review uncertainty uterine cervix dysplasia EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170030838 PUI L613955167 DOI 10.11124/jbisrir-2016-2270 FULL TEXT LINK http://dx.doi.org/10.11124/jbisrir-2016-2270 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 92 TITLE Adjuvant treatment for older women with invasive breast cancer AUTHOR NAMES Jolly T.A. Williams G.R. Bushan S. Pergolotti M. Nyrop K.A. Jones E.L. Muss H.B. AUTHOR ADDRESSES (Jolly T.A., trevor_jolly@med.unc.edu; Williams G.R.; Nyrop K.A.; Muss H.B.) Hematology and Oncology Division, University of North Carolina, Chapel Hill, United States. (Jolly T.A., trevor_jolly@med.unc.edu; Williams G.R.) Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina, Chapel Hill, United States. (Jolly T.A., trevor_jolly@med.unc.edu; Williams G.R.; Nyrop K.A.; Muss H.B.) Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States. (Bushan S.) Department of Medicine/School of Medicine, University of North Carolina, Chapel Hill, United States. (Pergolotti M.) Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States. (Jones E.L.) Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States. CORRESPONDENCE ADDRESS T.A. Jolly, Hematology and Oncology Division, University of North Carolina, Chapel Hill, United States. Email: trevor_jolly@med.unc.edu SOURCE Women's Health (2016) 12:1 (129-146). Date of Publication: 1 Jan 2016 ISSN 1745-5065 (electronic) 1745-5057 BOOK PUBLISHER Future Medicine Ltd., info@futuremedicine.com ABSTRACT Older women experience a large share of breast cancer incidence and death. With the projected rise in the number of older cancer patients, adjuvant chemo-, radiation and endocrine therapy management will become a key component of breast cancer treatment in older women. Many factors influence adjuvant treatment decisions including patient preferences, life expectancy and tumor biology. Geriatric assessment predicts important outcomes, identifies key deficits, and can aid in the decision making process. This review utilizes clinical vignettes to illustrate core principles in adjuvant management of breast cancer in older women and suggests an approach incorporating life expectancy and geriatric assessment. EMTREE DRUG INDEX TERMS aromatase inhibitor (adverse drug reaction, clinical trial, drug therapy) carboplatin (drug combination, drug therapy) cyclophosphamide (drug combination, drug therapy) docetaxel (drug combination, drug therapy) doxorubicin (drug combination, drug therapy) fluorouracil (drug combination, drug therapy) letrozole (clinical trial, drug comparison - placebo, drug therapy) methotrexate (drug combination, drug therapy) paclitaxel (drug combination, drug therapy) placebo tamoxifen (adverse drug reaction, clinical trial, drug therapy) trastuzumab (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy, surgery) cancer adjuvant therapy geriatric care EMTREE MEDICAL INDEX TERMS aged aging arthralgia (side effect) article bone disease (side effect) breast surgery cancer classification cancer control cancer hormone therapy cancer recurrence clinical trial (topic) distant metastasis free survival drug efficacy drug safety drug tolerability endometrium cancer (side effect) fracture (side effect) functional status geriatric assessment hot flush (side effect) human Karnofsky Performance Status life expectancy life extension medical decision making meta analysis (topic) myalgia (side effect) outcome assessment overall survival phase 3 clinical trial (topic) practice guideline progression free survival quality of life randomized controlled trial (topic) recurrence risk risk benefit analysis systematic review (topic) tumor invasion vein thrombosis (side effect) women's health CAS REGISTRY NUMBERS carboplatin (41575-94-4) cyclophosphamide (50-18-0) docetaxel (114977-28-5) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) letrozole (112809-51-5) methotrexate (15475-56-6, 59-05-2, 7413-34-5) paclitaxel (33069-62-4) tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Gerontology and Geriatrics (20) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160064191 MEDLINE PMID 26767315 (http://www.ncbi.nlm.nih.gov/pubmed/26767315) PUI L607883182 DOI 10.2217/whe.15.92 FULL TEXT LINK http://dx.doi.org/10.2217/whe.15.92 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 93 TITLE Development and testing of a decision aid for women considering neoadjuvant systemic therapy for operable breast cancer (study in progress) AUTHOR NAMES Zdenkowski N. Sproule V. Hutchings E. Butow P. Boyle F. AUTHOR ADDRESSES (Zdenkowski N.; Hutchings E.) Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia. (Zdenkowski N.; Butow P.; Boyle F.) University of Sydney, Newcastle, Australia. (Zdenkowski N.; Boyle F.) University of Newcastle, Newcastle, Australia. (Sproule V.) Calvary Mater Newcastle Hospital, Newcastle, Australia. CORRESPONDENCE ADDRESS N. Zdenkowski, Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2015) 11 SUPPL. 5 (18). Date of Publication: December 2015 CONFERENCE NAME Hunter Cancer Research Alliance Annual Symposium 2015 CONFERENCE LOCATION New Lambton Heights, NSW, Australia CONFERENCE DATE 2015-11-27 to 2015-11-27 ISSN 1743-7563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Neoadjuvant systemic therapy (NAST) has gained popularity for women with larger or more proliferative, operable breast cancer in routine care and as part of a clinical trial. It adds complexity which limits women's ability to engage fully in the decision-making. Patients report either not being offered NAST, or not being as involved in the decision as they would like. Clinicians report typically directing the decision about NAST, and are interested in offering a decision aid (DA). Patient DAs can increase patients' involvement in decision-making, but a systematic review did not identify a neoadjuvant breast cancer DA. Aims: To develop a patient DA for NAST and test its acceptability, feasibility and impact on decision-related outcomes. Methods: The design and content of the DA was based on: interviews with patients, a survey of clinicians; literature review; expert consensus; and the International Patient Decision Aid Standards criteria for DA development. The DA includes: a balanced description of the advantages and disadvantages of systemic therapy followed by surgery, or the reverse sequence; graphical and written representation of outcome probabilities; and a values clarification exercise. The DA is currently being evaluated in a prospective single-arm pre-post study. Primary endpoints are DA acceptability to patients and clinicians, and feasibility of use. Secondary endpoints include decisional conflict, knowledge, information and involvement preferences, control preferences, distress, anxiety, satisfaction and regret. Results: Between July and September 2015, 8 NAST candidates out of a sample size of 50 have registered to this ongoing study at 4 sites in Newcastle, Sydney and Melbourne. Conclusions: This study intends to provide a new resource designed to be implementable within routine clinical practice to improve decision-making, and support clinicians to offer NAST to eligible patients. Translational research aspect: T2-T3 research: the development and testing of a new intervention; and facilitating quality evidence-based treatment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer research female human systemic therapy EMTREE MEDICAL INDEX TERMS anxiety arm clinical practice clinical trial consensus decision making evidence based practice exercise interview patient sample size satisfaction surgery systematic review systematic review (topic) translational research LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72331383 DOI 10.1111/ajco.12444 FULL TEXT LINK http://dx.doi.org/10.1111/ajco.12444 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 94 TITLE Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case–Control Study AUTHOR NAMES Collins L.C. Achacoso N. Haque R. Nekhlyudov L. Quesenberry C.P. Schnitt S.J. Habel L.A. Fletcher S.W. AUTHOR ADDRESSES (Collins L.C., lcollins@bidmc.harvard.edu; Schnitt S.J.) Department of Pathology, Beth Israel Deaconess Medical Center, Boston, United States. (Collins L.C., lcollins@bidmc.harvard.edu; Nekhlyudov L.; Schnitt S.J.; Fletcher S.W.) Harvard Medical School, Boston, United States. (Achacoso N.; Quesenberry C.P.; Habel L.A.) Kaiser Permanente, Northern CA, Oakland, United States. (Haque R.) Kaiser Permanente, Southern CA, Pasadena, United States. (Nekhlyudov L.) Harvard Vanguard Medical Associates, Boston, United States. (Nekhlyudov L.; Fletcher S.W.) Harvard Pilgrim Health Care Institute, Boston, United States. CORRESPONDENCE ADDRESS L.C. Collins, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, United States. Email: lcollins@bidmc.harvard.edu SOURCE Annals of Surgical Oncology (2015) 22 Supplement 3 (502-508). Date of Publication: 1 Dec 2015 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Various patient, treatment, and pathologic factors have been associated with an increased risk of local recurrence (LR) following breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS). However, the strength and importance of individual factors has varied; whether combining factors improves prediction, particularly in community practice, is uncertain. In a large, population-based cohort of women with DCIS treated with BCT in three community-based practices, we assessed the validity of the Memorial Sloan-Kettering Cancer Center (MSKCC) DCIS nomogram, which combines clinical, pathologic, and treatment features to predict LR. Methods: We reviewed slides of patients with unilateral DCIS treated with BCT. Regression methods were used to estimate risks of LR. The MSKCC DCIS nomogram was applied to the study population to compare the nomogram-predicted and observed LR at 5 and 10 years. Results: The 495 patients in our study were grouped into quartiles and octiles to compare observed and nomogram-predicted LR. The 5-year absolute risk of recurrence for lowest and highest quartiles was 4.8 and 33.1 % (95 % CI 3.1–6.4 and 24.2–40.9, respectively; p < 0.0001). The overall correlation between 10-year nomogram-predicted recurrences and observed recurrences was 0.95. Compared with observed 10-year LR rates, the risk estimates provided by the nomogram showed good correlation, and reasonable discrimination with a c-statistic of 0.68. Conclusions: The MSKCC DCIS nomogram provided good prediction of the 5- and 10-year LR when applied to a population of patients with DCIS treated with BCT in a community-based practice. This nomogram, therefore, is a useful treatment decision aid for patients with DCIS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast conserving therapy cancer risk cancer therapy health care practice intraductal carcinoma (surgery) EMTREE MEDICAL INDEX TERMS adult aged article cancer patient cancer surgery case control study disease association female follow up health care delivery human major clinical study partial mastectomy prediction surgical patient tumor invasion EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015121332 MEDLINE PMID 26059650 (http://www.ncbi.nlm.nih.gov/pubmed/26059650) PUI L604831007 DOI 10.1245/s10434-015-4641-x FULL TEXT LINK http://dx.doi.org/10.1245/s10434-015-4641-x COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 95 TITLE Impact of a decision aid on reducing uncertainty: pilot study of women in their 40s and screening mammography AUTHOR NAMES Scariati P. Nelson L. Watson L. Bedrick S. Eden K.B. AUTHOR ADDRESSES (Scariati P., scariati@vcom.vt.edu) Marin General Hospital, Greenbrae, CA, USA (Nelson L., lisapnelson@gmail.com) ConvergeHEALTH by Deloitte, Newton, MA, USA (Watson L.) Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. watsolin@ohsu.edu (Bedrick S., bedricks@ohsu.edu) Center for Spoken Language and Understanding, Oregon Health & Science University, Portland, OR, USA (Eden K.B., edenk@ohsu.edu.Pacific) Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA (Eden K.B., edenk@ohsu.edu.Pacific) Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA SOURCE BMC medical informatics and decision making (2015) 15 (89). Date of Publication: 10 Nov 2015 ISSN 1472-6947 (electronic) ABSTRACT BACKGROUND: In 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40. Inconsistencies in data regarding the benefit versus risk of routine screening for women less than 50-years-of-age led to a second recommendation - that women in their forties engage in a shared decision making process with their provider to make an individualized choice about screening mammography that was right for them. In response, a web-based interactive mammography screening decision aid was developed and evaluated.METHODS: The decision aid was developed using an agile, iterative process. It was further honed based on feedback from clinical and technical subject matter experts. A convenience sample of 51 age- and risk-appropriate women was recruited to pilot the aid. Pre-post decisional conflict and screening choice was assessed.RESULTS: Women reported a significant reduction in overall decisional conflict after using the decision aid (Z =  -5.3, p < 0.001). These participants also reported statistically significant reductions in each of the decisional conflict subscales: feeling uncertain (Z = -4.7, p < 0.001), feeling uninformed (Z = -5.2, p < 0.001), feeling unclear about values (Z = -5.0, p < 0.001), and feeling unsupported (Z =  -4.0, p < 0.001). However, a woman's intention to obtain a screening mammogram in the next 1-2 years was not significantly changed (Wilcoxon signed-rank Z = -1.508, p = 0.132).CONCLUSION: This mammography screening decision aid brings value to patient care not by impacting what a woman chooses but by lending clarity to why or how she chooses it. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system mammography patient preference uncertainty EMTREE MEDICAL INDEX TERMS adult breast tumor (diagnosis, prevention) female human middle aged pilot study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26554555 (http://www.ncbi.nlm.nih.gov/pubmed/26554555) PUI L615911077 DOI 10.1186/s12911-015-0210-2 FULL TEXT LINK http://dx.doi.org/10.1186/s12911-015-0210-2 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 96 TITLE Quality of online information to support patient decision-making in breast cancer surgery AUTHOR NAMES Bruce J.G. Tucholka J.L. Steffens N.M. Neuman H.B. AUTHOR ADDRESSES (Bruce J.G.; Neuman H.B., neuman@surgery.wisc.edu) School of Medicine and Public Health, University of Wisconsin, Madison, United States. (Tucholka J.L.; Steffens N.M.; Neuman H.B., neuman@surgery.wisc.edu) Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Wisconsin Surgical Outcomes Research Program, Madison, United States. (Neuman H.B., neuman@surgery.wisc.edu) Carbone Cancer Center, University of Wisconsin, Madison, United States. CORRESPONDENCE ADDRESS H.B. Neuman, H4/726 CSC, 600 Highland Ave, Madison, United States. Email: neuman@surgery.wisc.edu SOURCE Journal of Surgical Oncology (2015) 112:6 (575-580). Date of Publication: 1 Nov 2015 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Methods Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." Results 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." Conclusion Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast surgery medical information online system patient decision making EMTREE MEDICAL INDEX TERMS article cancer surgery human mastectomy priority journal publication EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015474420 MEDLINE PMID 26417898 (http://www.ncbi.nlm.nih.gov/pubmed/26417898) PUI L606628657 DOI 10.1002/jso.24046 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24046 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 97 TITLE Assessment of Breast Cancer Patients' Knowledge and Decisional Conflict Regarding Tamoxifen Use AUTHOR NAMES Kim S.I. Lee Y. Son Y. Jun S.Y. Yun S. Bae H.S. Lim M.C. Jung S.-Y. Joo J. Lee E.S. AUTHOR ADDRESSES (Kim S.I.) Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. ; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Lee Y.; Son Y.; Jun S.Y.; Bae H.S.) Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Yun S.; Joo J.) Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Lim M.C.) Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea. ; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea (Jung S.-Y.; Lee E.S.) Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea SOURCE Journal of Korean medical science (2015) 30:11 (1604-1610). Date of Publication: 1 Nov 2015 ISSN 1598-6357 (electronic) ABSTRACT Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (≥ college) was associated with a higher, total knowledge score (β = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (β = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (β = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict. EMTREE DRUG INDEX TERMS antineoplastic hormone agonists and antagonists (adverse drug reaction, drug therapy) tamoxifen (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chemically induced statistics and numerical data EMTREE MEDICAL INDEX TERMS adult aged attitude to health breast tumor (drug therapy, epidemiology) decision making endometrium tumor (epidemiology, prevention) female health survey human informed consent middle aged patient education patient participation prevalence risk assessment South Korea CAS REGISTRY NUMBERS tamoxifen (10540-29-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26539004 (http://www.ncbi.nlm.nih.gov/pubmed/26539004) PUI L615903115 DOI 10.3346/jkms.2015.30.11.1604 FULL TEXT LINK http://dx.doi.org/10.3346/jkms.2015.30.11.1604 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 98 TITLE Breast cancer patients' preferences for adjuvant radiation therapy post lumpectomy, whole-breast irradiation versus partial-breast irradiation: A single-institutional study AUTHOR NAMES Szumacher E. McGuffin M. Presutti R. Harth T. Mesci A. Feldman-Stewart D. Chow E. Di Prospero L. Vesprini D. Rakovitch E. Lee J. Doherty M. Soliman H. Ackerman I. Cao X. Kiss A. Pignol J.P. AUTHOR ADDRESSES (Szumacher E.; McGuffin M.; Presutti R.; Harth T.; Di Prospero L.; Vesprini D.; Rakovitch E.; Lee J.; Doherty M.; Ackerman I.; Cao X.; Kiss A.) Sunnybrook Health Sciences Centre, Toronto, Canada. (Szumacher E.; Mesci A.; Chow E.; Vesprini D.; Rakovitch E.; Lee J.; Doherty M.; Soliman H.; Ackerman I.) University of Toronto, Toronto, Canada. (Feldman-Stewart D.) Queen's Cancer Research Institute, Kingston, Canada. (Chow E.; Soliman H.) Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, Canada. (Pignol J.P.) Erasmus MC: University Medical Centre, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS E. Szumacher, Sunnybrook Health Sciences Centre, Toronto, Canada. SOURCE International Journal of Radiation Oncology Biology Physics (2015) 93:3 SUPPL. 1 (E41). Date of Publication: 1 Nov 2015 CONFERENCE NAME 57th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2015 CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-10-18 to 2015-10-21 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Whole breast irradiation (WBI) is the standard regimen of radiation therapy following lumpectomy for early stage breast cancer. Recently, interest in partial breast irradiation (PBI) as an alternative to WBI has increased. However, the preference of patients as to what type of radiation therapy regimen they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer prefer PBI or WBI and to identify important factors for patients when making this decision. Materials/Methods: Based on our previous study of early stage breast cancer patient information needs, the relevant literature and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients with early stage breast cancer referred for adjuvant radiation therapy at a large academic cancer center were invited to participate. Women over age 40 with a new diagnosis of breast cancer treated with breast conserving surgery showing clear margins and negative axillary nodes were eligible. Descriptive statistics were calculated for all variables. Responses to survey questions were compared between patients who preferred WBI versus PBI using Chi-square analyses or Fisher's exact tests. Results: One hundred twenty-six patients were approached and 90 completed the survey. Twenty-seven (30%) preferred PBI and 55 (61%) preferred WBI. Eight patients (9%) either required more information or had no preference. Of the patients who chose WBI, 32 (58%) preferred hypofractionated radiation therapy while 14 (26%) preferred conventional radiation therapy and nine (16%) had no preference. Patients rated several factors as important, including convenience [PBI = 18/26 (69%), WBI = 36/54 (67%)], radiation dose [PBI = 20/26 (80%), WBI = 46/55 (83%)], invasiveness [PBI = 18/26 (69%), WBI = 43/53 (81%)], recurrence rate [PBI = 26/26 (100%), WBI = 55/55 (100%)], survival [PBI = 26/26 (100%), WBI = 54/55 (98%)], side effects [PBI = 21/26 (81%), WBI = 47/55 (85%)] effectiveness [PBI = 25/26 (96%), WBI = 54/54 (100%)] and radiation dose to surrounding organs [PBI = 23/26 (88%), WBI = 52/54 (95%)]. The only factor that was significantly different between the groups was standard method of treatment [PBI = 16/26 (61%), WBI = 52/54 (96%), chi-square = 16.63, p = 0.001]. Conclusion: Our study shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. There is significant association between treatment preference and the rating of standard treatment as important. Patients preferring WBI were more likely to consider standard treatment as important compared to those preferring PBI. A detailed analysis of all decisional preferences between WBI and PBI will be presented at the meeting. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast breast cancer cancer patient human irradiation oncology partial mastectomy radiotherapy society EMTREE MEDICAL INDEX TERMS adjuvant therapy cancer center chi square test consensus diagnosis female Fisher exact test patient patient information questionnaire radiation dose recurrence risk side effect statistics survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72109532 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 99 TITLE onlineDeCISion.org: a web-based decision aid for DCIS treatment AUTHOR NAMES Ozanne E.M. Schneider K.H. Soeteman D. Stout N. Schrag D. Fordis M. Punglia R.S. AUTHOR ADDRESSES (Ozanne E.M., elissa.m.ozanne@dartmouth.edu) Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, United States. (Schneider K.H.) Baylor College of Medicine, Houston, United States. (Soeteman D.) Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, United States. (Stout N.) Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, United States. (Schrag D.; Punglia R.S.) Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, United States. (Fordis M.) Center for Collaborative and Interactive Technologies and the John M. Eisenberg Center for Clinical Decisions and Communications Science, Baylor College of Medicine, One Baylor Plaza, MS: BCM: 155, Houston, United States. CORRESPONDENCE ADDRESS E.M. Ozanne, Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, United States. Email: elissa.m.ozanne@dartmouth.edu SOURCE Breast Cancer Research and Treatment (2015) 154:1 (181-190). Date of Publication: 16 Oct 2015 ISSN 1573-7217 (electronic) 0167-6806 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer therapy intraductal carcinoma medical decision making software EMTREE MEDICAL INDEX TERMS age article cancer radiotherapy cancer recurrence cancer survival conceptual framework disease free survival human life expectancy microsimulation overall survival partial mastectomy priority journal recurrence risk semi structured interview simulation treatment outcome tumor invasion EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015455676 MEDLINE PMID 26475704 (http://www.ncbi.nlm.nih.gov/pubmed/26475704) PUI L606508666 DOI 10.1007/s10549-015-3605-y FULL TEXT LINK http://dx.doi.org/10.1007/s10549-015-3605-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 100 TITLE Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: Study protocol for a cluster randomized controlled trial AUTHOR NAMES Berger-Höger B. Liethmann K. Mühlhauser I. Haastert B. Steckelberg A. AUTHOR ADDRESSES (Berger-Höger B., Birte.Berger-Hoeger@uni-hamburg.de; Liethmann K., Katrin.Liethmann@uni-hamburg.de; Mühlhauser I., Ingrid_Muehlhauser@uni-hamburg.de; Steckelberg A., ASteckelberg@uni-hamburg.de) University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, Hamburg, Germany. (Haastert B., haastert@medistatistica.de) Medi Statistica Neuenrade, Lambertusweg 1b, Neuenrade, Germany. CORRESPONDENCE ADDRESS B. Berger-Höger, University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, Hamburg, Germany. SOURCE Trials (2015) 16:1 Article Number: 452. Date of Publication: 12 Oct 2015 ISSN 1745-6215 (electronic) BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Background: Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. Methods/Design: A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2hours) and specialized breast care and oncology nurses (4days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-O(dyad) (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-O(nurse), MAPPIN-O(physician), MAPPIN-O(patient), MAPPIN-Q(nurse), MAPPIN-Q(patient) and MAPPIN-Q(physician)), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. Discussion: To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. Trial registration: Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision coaching decision making informed shared decision making intraductal carcinoma (radiotherapy, surgery) therapy EMTREE MEDICAL INDEX TERMS adult article clinical protocol controlled study evidence based practice female human nurse outcome assessment patient care patient participation physician randomized controlled trial EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) CLINICAL TRIAL NUMBERS ISRCTN (ISRCTN46305518) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015445304 PUI L606362382 DOI 10.1186/s13063-015-0991-8 FULL TEXT LINK http://dx.doi.org/10.1186/s13063-015-0991-8 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 101 TITLE An analysis of the decision-making process for contralateral prophylactic mastectomy and breast reconstruction AUTHOR NAMES Buchanan P.J. Abdulghani M. Waljee J.F. Kozlow J.H. Newman L.A. Chung K.C. Momoh A.O. AUTHOR ADDRESSES (Buchanan P.J.; Abdulghani M.; Waljee J.F.; Kozlow J.H.; Newman L.A.; Chung K.C.; Momoh A.O.) University of Michigan, Ann Arbor, United States. CORRESPONDENCE ADDRESS P.J. Buchanan, University of Michigan, Ann Arbor, United States. SOURCE Journal of the American College of Surgeons (2015) 221:4 SUPPL. 1 (S18). Date of Publication: October 2015 CONFERENCE NAME 101st Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2015-10-04 to 2015-10-08 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: The aim of this study was to explore factors critical to patient medical decision-making for contralateral prophylactic mastectomy (CPM) and reconstruction among women with early stage, unilateral breast cancer. METHODS: A mixed method (qualitative and quantitative) approach was used to gain an understanding of patient choices and experiences. Patients with unilateral breast cancer, managed at the University of Michigan, were recruited using purposeful sampling. Semi-structured interviews were conducted and qualitative outcomes were assessed. Patient-reported outcomes were evaluated using the Concerns About Recurrence Scale (CARS) and BREAST-Q. RESULTS: Thirty patients were enrolled; 13 (43%) underwent unilateral mastectomy and 17 (57%) underwent CPM with reconstruction. Patients who chose CPM endorsed decisions made without regard for scientific evidence, based primarily on worry about recurrence. Quality of life after mastectomy, in both groups, was characterized by relief from worry. Patient desires for symmetry played a secondary role in supporting the decision for CPM. Based on the CARS survey, a greater proportion of patients who underwent CPM reported moderate to high levels of health worries (66.7% vs 57%). Patients with CPM had higher mean scores for Satisfaction with Breast (82.2 vs 70.6), Satisfaction with Outcome (90.8 vs 75.2), and Sexual Well-being (73.6 vs 67). CONCLUSIONS: The choice for CPM is greatly influenced by fear of recurrence, in spite of patient education on risk of recurrence. Though CPM may not provide an oncologic benefit, its potential effect on satisfaction and relief of worry provides some justification for its use. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast reconstruction college decision making human mastectomy surgeon EMTREE MEDICAL INDEX TERMS breast breast cancer evidence based practice fear female health medical decision making patient patient education patient worry quality of life risk sampling satisfaction semi structured interview United States university wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72170014 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 102 TITLE Cost-effectiveness analysis of contralateral prophylactic mastectomy compared to unilateral mastectomy with routine surveillance for unilateral, sporadic breast cancer AUTHOR NAMES Keskey R.C. LaJoie A.S. Roberts A. Frick K.D. Kim I.K. Sutton B.S. Cheadle W.G. Ajkay N. AUTHOR ADDRESSES (Keskey R.C.; LaJoie A.S.; Roberts A.; Frick K.D.; Kim I.K.; Sutton B.S.; Cheadle W.G.; Ajkay N.) University of Louisville School of Medicine, Louisville, KY, Johns Hopkins University, Baltimore, MD, University of Toronto, Toronto, ON CORRESPONDENCE ADDRESS R.C. Keskey, SOURCE Journal of the American College of Surgeons (2015) 221:4 SUPPL. 1 (S19). Date of Publication: October 2015 CONFERENCE NAME 101st Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2015-10-04 to 2015-10-08 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: Contralateral prophylactic mastectomy (CPM) in younger women with unilateral breast cancer (BC) has more than doubled. Studies of cost and quality of life of the procedure remain inconclusive. METHODS: A cost-effectiveness analysis using a decision-tree model in TreeAge Pro 2015 was used to compare long-term costs and quality of life after unilateral mastectomy (UM) with routine surveillance vs CPM for sporadic BC in women younger than 50 years of age. A 10-year risk period for contralateral breast cancer (CBC), reconstruction, wound complications, cost of routine surveillance, and treatment for CBC were used in the model to estimate accrued costs. In addition, a societal perspective was used to estimate quality adjusted life years (QALYs) after either treatment for a period of 20 years. Medical costs were obtained from the 2014 Medicare physician fee schedule and event probabilities were taken from recent literature. RESULTS: The mean cost of UM with surveillance was $10,185 and CPM was $14,294. Treatment with UM resulted in $4,109 less in costs, yet a gain of 0.21 QALYs when compared with CPM over 20 years of follow-up. The resulting incremental cost effectiveness ratio is a savings of $19,566 per QALY gained when patients undergo UM. Even under worst-case scenario and varying assumptions, UM cost and quality dominated CPM. CONCLUSIONS: From this refined model, UM costs less and provides a better quality of life. Regardless of expected outcome, patients electing to undergo UM with routine surveillance gain several months of life in optimal health at a lower overall cost when compared with patients choosing CPM. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast cancer college cost effectiveness analysis human mastectomy surgeon EMTREE MEDICAL INDEX TERMS decision tree fee female follow up health medical fee medicare model patient procedures quality adjusted life year quality of life risk wound complication LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72170017 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 103 TITLE The effect of personal medical history and family history of cancer on the uptake of risk-reducing salpingo-oophorectomy AUTHOR NAMES Van Der Aa J.E. Hoogendam J.P. Butter E.S.F. Ausems M.G.E.M. Verheijen R.H.M. Zweemer R.P. AUTHOR ADDRESSES (Van Der Aa J.E.; Hoogendam J.P.; Butter E.S.F.; Verheijen R.H.M.; Zweemer R.P.) Gynaecological Oncology, University Medical Center Utrecht, Utrecht, Netherlands. (Ausems M.G.E.M.) Medical Genetics, University Medical Center Utrecht, Utrecht, Netherlands. CORRESPONDENCE ADDRESS J.E. Van Der Aa, Gynaecological Oncology, University Medical Center Utrecht, Utrecht, Netherlands. SOURCE International Journal of Gynecological Cancer (2015) 25:9 SUPPL. 1 (573). Date of Publication: October 2015 CONFERENCE NAME 19th International Meeting of the European Society of Gynaecological Oncology, ESGO 2015 CONFERENCE LOCATION Nice, France CONFERENCE DATE 2015-10-24 to 2015-10-27 ISSN 1048-891X BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Women with an increased lifetime risk of ovarian cancer (e.g. BRCA1/2 mutation carriers) are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) to reduce risk of developing ovarian, fallopian tube and peritoneal cancer. We investigated the uptake of risk-reducing salpingo-oophorectomy (RRSO) and evaluated the influence of personal medical history of (breast) cancer, risk-reducing mastectomy (RRM) and family history of ovarian and/or breast cancer on the decision of undergoing RRSO. This single center retrospective observational cohort study was performed in a tertiary multidisciplinary clinic for hereditary cancer of the University Medical Centre Utrecht, the Netherlands. Women ≥35 years old with an estimated lifetime risk of ovarian cancer ≥10%, who had completed childbearing, were eligible for RRSO. Uptake and timing of RRSO were analyzed. Influence of personal medical history and family history on RRSO decision making, were uni- and multivariably evaluated with logistic regression. The study population consisted of 218 women (45.0% BRCA1 mutation carrier, 28.0% BRCA1 mutation carrier, 27.0% with familial susceptibility) in whom RRSO uptake was 87.2%. The median age at RRSO was 44.5 (range 28-73). Of the women undergoing RRSO, 78.3% needed ≤3 gynecologic consultations to come to this decision. Multivariable regression analysis showed a significant difference in RRSO uptake for women with a history of RRM (OR 3.66 95% CI (1.12-11.98)), but no significant difference in RRSO uptake for women with a history of breast cancer (OR 1.38 95% CI (0.50-3.79), nor with a family history of ovarian and/or breast cancer (OR 1.10 95% CI (0.44-2.76)). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) European family history human medical history neoplasm oncology risk salpingooophorectomy society EMTREE MEDICAL INDEX TERMS breast breast cancer cancer risk cohort analysis consultation decision making Fallopian tube female hereditary tumor hospital lifespan logistic regression analysis mastectomy mutation Netherlands ovary cancer peritoneum cancer population pregnancy regression analysis university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72077104 DOI 10.1097/01.IGC.0000473498.85773.6e FULL TEXT LINK http://dx.doi.org/10.1097/01.IGC.0000473498.85773.6e COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 104 TITLE Hereditary breast cancer-diagnosis, prevention, treatment AUTHOR NAMES Morlot S. Schlegelberger B. AUTHOR ADDRESSES (Morlot S.; Schlegelberger B.) Hannover Medical School, Institute of Human Genetics, Hannover, Germany. CORRESPONDENCE ADDRESS S. Morlot, Hannover Medical School, Institute of Human Genetics, Hannover, Germany. SOURCE Oncology Research and Treatment (2015) 38 SUPPL. 5 (102). Date of Publication: October 2015 CONFERENCE NAME Jahrestagung der Deutschen, Osterreichischen und Schweizerischen Gesellschaften fur Hamatologie und Medizinische Onkologie 2015 CONFERENCE LOCATION Basel, Switzerland CONFERENCE DATE 2015-10-09 to 2015-10-13 ISSN 2296-5270 BOOK PUBLISHER S. Karger AG ABSTRACT Approximately 5% of all breast cancers and more than 10% of all ovarian cancers occur as a result of a hereditary predisposition. Possible indications of a hereditary cause can be found in the family and patient's own medical history (frequent breast, ovarian cancer, pancreatic and/or prostate cancer in the family, young age, triple-negative breast cancer, bilateral breast cancer, male breast cancer, serous ovarian cancer). In about 20-25% of these “high-risk” families, a mutation can be found in one of the known tumor predisposition genes (BRCA1, BRCA2, CHEK2 and other DNA repair genes). It is of the utmost importance to identify these “high-risk” families in order to offer 1) intensified screening measures, e.g. breast screening including breast MRI or early detection of pancreatic cancer, 2) prophylactic surgery, particularly prophylactic salpingo-oophorectomy and 3) predictive testing of healthy family members. The knowledge of a BRCA1 or BRCA2 mutation has implications for treatment: due to the significantly increased risk of secondary breast cancer (ipsilateral or contralateral) after the first diagnosis of breast cancer, therapeutic (and prophylactic contralateral) mastectomy versus breast-conserving therapy and radiotherapy have to be discussed. Chemotherapy may be adapted because of the better response to platinum derivatives and the promising new PARP inhibitors. Fast-track genetic diagnostics can be carried out within a few days to aid decision-making. EMTREE DRUG INDEX TERMS DNA nicotinamide adenine dinucleotide adenosine diphosphate ribosyltransferase inhibitor platinum derivative EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer diagnosis prevention EMTREE MEDICAL INDEX TERMS breast chemotherapy decision making diagnosis disease predisposition DNA repair female gene human male male breast cancer mastectomy medical history mutation neoplasm nuclear magnetic resonance imaging ovary cancer pancreas cancer patient prostate cancer radiotherapy risk salpingooophorectomy screening surgery therapy triple negative breast cancer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72071004 DOI 10.1159/000439070 FULL TEXT LINK http://dx.doi.org/10.1159/000439070 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 105 TITLE A treatment threshold for decision making in breast cancer surgery for optimal quality of life AUTHOR NAMES Vos E. Koppert L. Van Lankeren W. Groot Koerkamp B. Hunink M. AUTHOR ADDRESSES (Vos E.; Koppert L.) Erasmus MC Cancer Institute, Surgery, Rotterdam, Netherlands. (Van Lankeren W.) Erasmus MC, Radiology, Rotterdam, Netherlands. (Groot Koerkamp B.) Erasmus MC, Surgery, Rotterdam, Netherlands. (Hunink M.) Erasmus MC, Epidemiology, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS E. Vos, Erasmus MC Cancer Institute, Surgery, Rotterdam, Netherlands. SOURCE European Journal of Cancer (2015) 51 SUPPL. 3 (S310-S311). Date of Publication: September 2015 CONFERENCE NAME European Cancer Congress 2015, ECC 2015 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2015-09-25 to 2015-09-29 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Since survival after breast conserving surgery (BCS) and mastectomy is equivalent, the choice for early stage breast cancer patients may rest upon quality of life (QoL) and cosmetic result considerations. It is believed that BCS entails a QoL benefit over mastectomy if a superior cosmesis is achieved, otherwise mastectomy may be preferred especially when considering breast reconstruction. The preoperative prediction of the cosmetic result after therapy should aid informed treatment decision making. Our aim was to determine the optimal threshold in the preoperative prediction of achieving superior cosmesis after BCS based on tumour volume versus breast volume ratio and location of the tumour in the breast. If the prediction exceeds the threshold, BCS will result in optimal QoL and if below the threshold, mastectomy will result in optimal QoL. Methods: A previously published study population was used of 69 invasive breast cancer women treated with breast conserving therapy and their longterm cosmetic result was evaluated by a panel. A preoperative prediction model was determined by logistic regression analysis to predict superior cosmesis after BCS representing our test with an area under the curve of 0.827 (95% CI 0.71-0.94). A decision tree for our test was built modelling the treatment consequences resulting in health states. To each health state a utility value (QoL weight on a 0-1 scale) was attached derived from the literature (for mastectomy) and our study population (for BCS). The treatment threshold - to perform BCS or not - was defined by the probability of superior cosmetic result after BCS at which the QoL of patients living with BCS and mastectomy is equal, which can be determined by direct comparison of the benefits and harms of BCS. The benefit was defined as the gain in QoL from superior cosmesis after BCS instead of mastectomy (with or without reconstruction) and the harm was defined by the loss in QoL from inferior cosmesis after BCS instead of mastectomy (with or without breast reconstruction). Results: The health states were: BCS with superior cosmesis, BCS with inferior cosmesis, mastectomy only, and mastectomy with breast reconstruction. Their utility values were 0.898, 0.862, 0.891, and 0.859 respectively. The breast reconstruction rate after mastectomy was 41.5% resulting in a utility for mastectomy (with or without reconstruction) of 0.877. The treatment threshold - to treat with BCS or not - was 0.462. Conclusions: The threshold of treatment with BCS versus mastectomy can be used in a preoperative treatment decision aid for breast cancer surgery with QoL as the primary outcome that incorporates the expected cosmetic result after BCS. Further improvement of the decision aid requires the more frequent use of utility values as part of QoL measurements in breast cancer patients. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery decision making European neoplasm quality of life EMTREE MEDICAL INDEX TERMS area under the curve breast breast reconstruction cancer patient decision tree female health status human logistic regression analysis mastectomy model partial mastectomy patient population prediction preoperative treatment survival therapy tumor volume weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72067545 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 106 TITLE Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment AUTHOR NAMES Fernandes-Taylor S. Adesoye T. Bloom J.R. AUTHOR ADDRESSES (Fernandes-Taylor S.; Adesoye T.; Bloom J.R.) aWisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin bSchool of Public Health, University of California at Berkeley, Berkeley, California, USA SOURCE Current opinion in supportive and palliative care (2015) 9:3 (279-284). Date of Publication: 1 Sep 2015 ISSN 1751-4266 (electronic) ABSTRACT RECENT FINDINGS: Young women undergoing treatment for breast cancer remain understudied despite unique needs. Psychoeducational interventions help to relieve symptoms and emotional distress during treatment, but effects do not appear to persist over the longer term. In the clinical context, the performance of prognostic-risk prediction models in this population is poor. Surgical decision-making is often driven by fear of recurrence and body image rather than prognosis, and decision aids may help young women to synthesize information to preserve their role in the treatment process.SUMMARY: First, shared decision-making, second, balancing body image, fear of recurrence, and recommended treatment, and third, palliative care for metastasis are essential research priorities for the clinical setting. In the larger social context, unique family/partner dynamics as well as financial and insurance concerns warrant particular attention in this population.PURPOSE OF REVIEW: This review examines recent literature on the psychosocial needs of and interventions for young women. We focus on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. This review summarizes research relevant to addressing their social and emotional concerns. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making EMTREE MEDICAL INDEX TERMS adult anxiety body image breast tumor (surgery) depression doctor patient relation family relation fear female human interpersonal communication mastectomy mental stress psychology quality of life risk assessment tumor recurrence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26164840 (http://www.ncbi.nlm.nih.gov/pubmed/26164840) PUI L610711995 DOI 10.1097/SPC.0000000000000161 FULL TEXT LINK http://dx.doi.org/10.1097/SPC.0000000000000161 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 107 TITLE Parental reasoning about growth attenuation therapy: report of a single-case study AUTHOR NAMES Kerruish N. McMillan J.R. AUTHOR ADDRESSES (Kerruish N.) Department of Women's and Children's Health and Bioethics Centre, University of Otago, Dunedin, New Zealand (McMillan J.R.) Bioethics Centre, University of Otago, Dunedin, New Zealand SOURCE Journal of medical ethics (2015) 41:9 (745-749). Date of Publication: 1 Sep 2015 ISSN 1473-4257 (electronic) ABSTRACT In 2006 a case report was published about a 6-year-old girl, Ashley, who has profound developmental disabilities and was treated with oestrogen patches to limit her final height, along with a hysterectomy and the removal of her breast buds. Ashley's parents claimed that attenuating her growth would make it possible for them to lift and move her more easily, facilitating greater involvement in family activities and making routine care more straightforward. The 'Ashley treatment' provoked public comment and academic debate and remains ethically controversial. As more children are being referred for such treatment, there is an urgent need to clarify how clinicians and ethics committees should respond to such requests. The controversy surrounding the Ashley treatment exists, at least in part, because of gaps in the literature, including a lack of empirical data about the outcomes for children who do and do not receive such treatment. However, we suggest in this paper that there is also merit in examining the parental decision-making process itself, and provide empirical data about the reasoning of one set of parents who ultimately chose part of this treatment for their child. Using the interview data, we illuminate some important points regarding how these parents characterise benefits and harms and their responsibilities as surrogate decision-makers. This analysis could inform decision-making about future requests for growth attenuation and might also have wider relevance to healthcare decision-making for children with profound cognitive impairment. EMTREE DRUG INDEX TERMS hormone (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child parent relation developmental disorder drug effects ethics handicapped child intellectual impairment medical ethics parent quality of life EMTREE MEDICAL INDEX TERMS adult child decision making female growth human hysterectomy male mastectomy preschool child professional standard psychology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25858291 (http://www.ncbi.nlm.nih.gov/pubmed/25858291) PUI L610858597 DOI 10.1136/medethics-2013-101913 FULL TEXT LINK http://dx.doi.org/10.1136/medethics-2013-101913 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 108 TITLE Tutorial dialogues and gist explanations of genetic breast cancer risk AUTHOR NAMES Widmer C.L. Wolfe C.R. Reyna V.F. Cedillos-Whynott E.M. Brust-Renck P.G. Weil A.M. AUTHOR ADDRESSES (Widmer C.L.; Wolfe C.R.; Reyna V.F.; Cedillos-Whynott E.M.; Brust-Renck P.G.; Weil A.M.) Miami University, Oxford, OH, USA, widmercl@miamioh.edu SOURCE Behavior research methods (2015) 47:3 (632-648). Date of Publication: 1 Sep 2015 ISSN 1554-3528 (electronic) ABSTRACT The intelligent tutoring system (ITS) BRCA Gist is a Web-based tutor developed using the Shareable Knowledge Objects (SKO) platform that uses latent semantic analysis to engage women in natural-language dialogues to teach about breast cancer risk. BRCA Gist appears to be the first ITS designed to assist patients' health decision making. Two studies provide fine-grained analyses of the verbal interactions between BRCA Gist and women responding to five questions pertaining to breast cancer and genetic risk. We examined how "gist explanations" generated by participants during natural-language dialogues related to outcomes. Using reliable rubrics, scripts of the participants' verbal interactions with BRCA Gist were rated for content and for the appropriateness of the tutor's responses. Human researchers' scores for the content covered by the participants were strongly correlated with the coverage scores generated by BRCA Gist, indicating that BRCA Gist accurately assesses the extent to which people respond appropriately. In Study 1, participants' performance during the dialogues was consistently associated with learning outcomes about breast cancer risk. Study 2 was a field study with a more diverse population. Participants with an undergraduate degree or less education who were randomly assigned to BRCA Gist scored higher on tests of knowledge than those assigned to the National Cancer Institute website or than a control group. We replicated findings that the more expected content that participants included in their gist explanations, the better they performed on outcome measures. As fuzzy-trace theory suggests, encouraging people to develop and elaborate upon gist explanations appears to improve learning, comprehension, and decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system genetics procedures EMTREE MEDICAL INDEX TERMS breast tumor female health education health literacy human semantics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25921818 (http://www.ncbi.nlm.nih.gov/pubmed/25921818) PUI L611496549 DOI 10.3758/s13428-015-0592-1 FULL TEXT LINK http://dx.doi.org/10.3758/s13428-015-0592-1 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 109 TITLE The effect of personal medical history and family history of cancer on the uptake of risk-reducing salpingo-oophorectomy AUTHOR NAMES van der Aa J.E. Hoogendam J.P. Butter E.S.F. Ausems M.G.E.M. Verheijen R.H.M. Zweemer R.P. AUTHOR ADDRESSES (van der Aa J.E.; Hoogendam J.P.; Butter E.S.F.; Verheijen R.H.M.; Zweemer R.P., r.zweemer@umcutrecht.nl) Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, Utrecht, Netherlands. (Ausems M.G.E.M.) Department of Medical Genetics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, Netherlands. CORRESPONDENCE ADDRESS R.P. Zweemer, Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, Utrecht, Netherlands. Email: r.zweemer@umcutrecht.nl SOURCE Familial Cancer (2015) 14:4 (539-544). Date of Publication: 12 Aug 2015 ISSN 1573-7292 (electronic) 1389-9600 BOOK PUBLISHER Kluwer Academic Publishers ABSTRACT Women with an increased lifetime risk of ovarian cancer are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) to reduce risk of adnexal cancer. We investigated the uptake of RRSO and evaluated the influence of personal medical history of (breast) cancer, risk-reducing mastectomy (RRM) and family history of ovarian and/or breast cancer on the RRSO decision. This single center retrospective observational cohort study was performed in a tertiary multidisciplinary clinic for hereditary cancer of the University Medical Centre Utrecht, the Netherlands. Women ≥35 years old with an estimated lifetime risk of ovarian cancer ≥10 %, who had completed childbearing, were eligible for RRSO. Uptake and timing of RRSO were analyzed. Influence of personal medical history and family history on RRSO decision making, were evaluated with logistic regression. The study population consisted of 218 women (45.0 % BRCA1 mutation carrier, 28.0 % BRCA2 mutation carrier, 27.0 % with familial susceptibility) with 87.2 % RRSO uptake. The median age at RRSO was 44.5 (range 28–73) years. Of the women undergoing RRSO, 78.3 % needed ≤3 consultations to reach this decision. Multivariable analysis showed a significant difference in RRSO uptake for women with a history of RRM [OR 3.66 95 % CI (1.12–11.98)], but no significant difference in women with a history of breast cancer [OR 1.38 95 % CI (0.50–3.79)], nor with a family history of ovarian and/or breast cancer [OR 1.10 95 % CI (0.44–2.76)]. We conclude that RRSO counseling, without the alternative of screening, is effective. The uptake is increased in women with a history of RRM. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anamnesis family history hereditary tumor (prevention, surgery) ovary cancer (prevention, surgery) salpingooophorectomy EMTREE MEDICAL INDEX TERMS adult aged article breast cancer cohort analysis decision making female first-degree relative heterozygote human major clinical study mastectomy observational study priority journal retrospective study risk reduction third-degree relative EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015298076 MEDLINE PMID 26264902 (http://www.ncbi.nlm.nih.gov/pubmed/26264902) PUI L605633163 DOI 10.1007/s10689-015-9827-7 FULL TEXT LINK http://dx.doi.org/10.1007/s10689-015-9827-7 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 110 TITLE Developing clinical decision tools to implement chronic disease prevention and screening in primary care: the BETTER 2 program (building on existing tools to improve chronic disease prevention and screening in primary care) AUTHOR NAMES Manca D.P. Campbell-Scherer D. Aubrey-Bassler K. Kandola K. Aguilar C. Baxter J. Meaney C. Salvalaggio G. Carroll J.C. Faria V. Nykiforuk C. Grunfeld E. AUTHOR ADDRESSES (Manca D.P., dpmanca@ualberta.ca.Covenant; Aguilar C., carolina.aguilar@ualberta.ca; Salvalaggio G., ginetta@ualberta.ca) Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada (Manca D.P., dpmanca@ualberta.ca.Covenant) Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, Alberta, T6L 5X8, Canada (Campbell-Scherer D.) Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, Alberta, T6G 2T4, Canada. dlcampbe@ualberta.ca (Campbell-Scherer D.) Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, Alberta, T6L 5X8, Canada. dlcampbe@ualberta.ca (Aubrey-Bassler K.) Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada. kaubrey@mun.ca (Kandola K., kami_kandola@gov.nt.ca; Faria V., vfaria@auroracollege.nt.ca) Department of Health and Social Services, Government of Northwest Territories, P.O. Box 1320, Yellowknife, Northwest Territories, X1A 2L9, Canada (Baxter J.) Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada. better.project@utoronto.ca (Meaney C., christopher.meaney@utoronto.ca; Carroll J.C., jcarroll@mtsinai.on.ca; Grunfeld E., eva.grunfeld@utoronto.ca.Ontario) Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada (Nykiforuk C., candace.nykiforuk@ualberta.ca) School of Public Health, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada (Grunfeld E., eva.grunfeld@utoronto.ca.Ontario) Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, Ontario, M5G 0A3, Canada () SOURCE Implementation science : IS (2015) 10 (107). Date of Publication: 4 Aug 2015 ISSN 1748-5908 (electronic) ABSTRACT BACKGROUND: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) trial demonstrated the effectiveness of an approach to chronic disease prevention and screening (CDPS) through a new skilled role of a 'prevention practitioner'(PP). The PP has appointments with patients 40-65 years of age that focus on primary prevention activities and screening of cancer (breast, colorectal, cervical), diabetes and cardiovascular disease and associated lifestyle factors. There are numerous and occasionally conflicting evidence-based guidelines for CDPS, and the majority of these guidelines are focused on specific diseases or conditions; however, primary care providers often attend to patients with multiple conditions. To ensure that high-level evidence guidelines were used, existing clinical practice guidelines and tools were reviewed and integrated into blended BETTER tool kits. Building on the results of the BETTER trial, the BETTER tools were updated for implementation of the BETTER 2 program into participating urban, rural and remote communities across Canada.METHODS: A clinical working group consisting of PPs, clinicians and researchers with support from the Centre for Effective Practice reviewed the literature to update, revise and adapt the integrated evidence algorithms and tool kits used in the BETTER trial. These resources are nuanced, based on individual patient risk, values and preferences and are designed to facilitate decision-making between providers across the target diseases and lifestyle factors included in the BETTER 2 program. Using the updated BETTER 2 toolkit, clinicians 1) determine which CDPS actions patients are eligible to receive and 2) develop individualized 'prevention prescriptions' with patients through shared decision-making and motivational interviewing.RESULTS: The tools identify the patients' risks and eligible primary CDPS activities: the patient survey captures the patient's health history; the prevention visit form and integrated CDPS care map identify eligible CDPS activities and facilitate decisions when certain conditions are met; and the 'bubble diagram' and 'prevention prescription' promote shared decision-making.CONCLUSION: The integrated clinical decision-making tools of BETTER 2 provide resources for clinicians and policymakers that address patients' complex care needs beyond single disease approaches and can be adapted to facilitate CDPS in the urban, rural and remote clinical setting.TRIAL REGISTRATION: The registration number of the original RCT BETTER trial was ISRCTN07170460 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system total quality management EMTREE MEDICAL INDEX TERMS chronic disease (prevention) human mass screening practice guideline preventive medicine primary health care procedures standards LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26238338 (http://www.ncbi.nlm.nih.gov/pubmed/26238338) PUI L615760440 DOI 10.1186/s13012-015-0299-9 FULL TEXT LINK http://dx.doi.org/10.1186/s13012-015-0299-9 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 111 TITLE Impact of preoperative evaluation of tumour grade by core needle biopsy on clinical risk assessment and patient selection for adjuvant systemic treatment in breast cancer AUTHOR NAMES Waaijer L. Willems S.M. Verkooijen H.M. Buck D.B. van der Pol C.C. van Diest P.J. Witkamp A.J. AUTHOR ADDRESSES (Waaijer L.) Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (Willems S.M.) Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands (Verkooijen H.M.) Departments of Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands (Buck D.B.) Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (van der Pol C.C.) Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands (van Diest P.J.) Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands (Witkamp A.J.) Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands SOURCE The British journal of surgery (2015) 102:9 (1048-1055). Date of Publication: 1 Aug 2015 ISSN 1365-2168 (electronic) ABSTRACT BACKGROUND: Histological characteristics are important when making a decision on adjuvant systemic treatment in breast cancer. Preoperative assessments of core needle biopsy (CNB) specimens are becoming increasingly relevant as novel minimally invasive ablative techniques are introduced, because a surgical specimen is no longer obtained with these methods. The clinical impact of potential underestimation of tumour grade on preoperative CNB on clinical decision-making was evaluated.METHODS: Histological tumour grade was reassessed on CNB and resection specimens from consecutive invasive ductal carcinomas diagnosed between 2010 and 2013. For each patient, the indication for systemic therapy was assessed, based on either CNB or surgical excision, in combination with clinical characteristics and imaging findings. The clinical impact of discordance between tumour grade on CNB versus the resection specimen was assessed.RESULTS: The analysis included 213 invasive ductal carcinomas in 199 patients. Discordance in tumour grade between CNB and the resection specimen was observed in 64 (30.0 per cent) of 213 tumours (κ = 0.53, 95 per cent c.i. 0.43 to 0.63). A decision on adjuvant treatment based on CNB would have resulted in overtreatment in seven (3.5 per cent) and undertreatment in three (1.5 per cent) of 199 patients. In the undertreated patients, incorrect omission of adjuvant systemic treatment would have increased the predicted 10-year mortality rate by 2.6-5.2 per cent and 10-year recurrence rate by 8.2-15.3 per cent based on the online risk assessment tool Adjuvant!CONCLUSION: The substantial discordance in tumour grading between CNB and resection specimens from breast cancer affects the indication for adjuvant therapy in only a small minority of patients with invasive ductal carcinoma. Assessment of tumour grade by CNB is feasible and accurate for the planning of postoperative treatment. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mastectomy pathology patient selection preoperative care EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult aged breast tumor (drug therapy, surgery) cancer grading decision support system evaluation study female human large core needle biopsy middle aged Paget nipple disease (drug therapy, surgery) retrospective study risk assessment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26176340 (http://www.ncbi.nlm.nih.gov/pubmed/26176340) PUI L606137123 DOI 10.1002/bjs.9858 FULL TEXT LINK http://dx.doi.org/10.1002/bjs.9858 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 112 TITLE Addressing the Potential Need for Coronary Artery Bypass Grafting After Free Tissue Transfer for Breast Reconstruction: An Algorithmic Approach AUTHOR NAMES Maher J.L. Mahabir R.C. Roehl K.R. AUTHOR ADDRESSES (Maher J.L.; Mahabir R.C.; Roehl K.R.) From the Division of Plastic Surgery, Scott & White Memorial Hospital; and Division of Plastic Surgery, Texas A&M Health Science Center, Temple, TX SOURCE Annals of plastic surgery (2015) 75:2 (140-143). Date of Publication: 1 Aug 2015 ISSN 1536-3708 (electronic) ABSTRACT The number one cause of death in American women is heart disease. Studies have clearly shown the superiority of internal mammary artery (IMA) grafts for coronary revascularization over other conduits or intracoronary techniques. Our goal was to design an algorithm for recipient vessel selection in patients undergoing free tissue transfer breast reconstruction.A review of the literature was performed to identify potential evidence to contribute to a best-practice guideline. The lack of high-level evidence led us to create a guideline based on a workgroup consensus, expert opinion, cadaveric studies, and case reports.As we operate on older patient populations, the need for IMA use for coronary artery bypass grafting (CABG) after autologous breast reconstruction may arise more frequently. We discuss the current literature regarding recipient vessel choices and level of recipient vessel harvest in free flap breast reconstruction to help continually evolve the practices of our specialty to the potential future needs of our patients. We also present a best-practice decision algorithm for vessel selection and harvest, as well as a sample case of CABG using the left IMA 35 days after previous autologous breast reconstruction using the left IMA.As the number of patients we operate on who may later require their IMA for CABG increases, so too must our understanding of the implications of our selection of recipient vessels for free autologous breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) algorithm coronary artery bypass graft decision support system procedures transplantation EMTREE MEDICAL INDEX TERMS breast reconstruction case report female free tissue graft human mammary artery middle aged risk assessment vascularization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26165568 (http://www.ncbi.nlm.nih.gov/pubmed/26165568) PUI L609733049 DOI 10.1097/SAP.0000000000000070 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000070 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 113 TITLE The evolving role of adjuvant radiotherapy for elderly women with early-stage breast cancer AUTHOR NAMES Rutter C.E. Lester-Coll N.H. Mancini B.R. Corso C.D. Park H.S. Yeboa D.N. Gross C.P. Evans S.B. AUTHOR ADDRESSES (Rutter C.E.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Lester-Coll N.H.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Mancini B.R.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Corso C.D.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Park H.S.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Yeboa D.N.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Gross C.P.) Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, Yale University, New Haven, Connecticut (Gross C.P.) Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut (Evans S.B.) Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (Evans S.B.) Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, Yale University, New Haven, Connecticut SOURCE Cancer (2015) 121:14 (2331-2340). Date of Publication: 15 Jul 2015 ISSN 1097-0142 (electronic) ABSTRACT BACKGROUND: Elderly patients with early-stage breast cancer (ESBC) derive a local control benefit from radiotherapy (RT) after lumpectomy, without any apparent effect on overall survival. Therefore, the use of RT is controversial. In the current study, the authors characterized updated trends in RT for elderly patients with estrogen receptor (ER)-positive ESBC.METHODS: Patients aged ≥70 years with ER-positive ESBC measuring ≤2 cm after lumpectomy with negative resection margins and known RT details were identified in the National Cancer Data Base. Patients were classified by year of diagnosis and segregated into 3 groups relative to the initial publication and updated presentation of the Cancer and Leukemia Group B (CALGB) 9343 trial. RT use overall, prescription of hypofractionated RT, and use of boost RT were compared between groups using logistic regression analysis, and the influence of clinicopathologic covariates was determined with multivariable logistic regression analysis.RESULTS: A total of 122,796 elderly patients with ER-positive ESBC who were diagnosed between 1998 and 2011 were identified. Overall, 84,649 patients (68.9%) received adjuvant RT, with a decline observed between successive cohorts (71.3% in the pre-initial publication cohort, 69.5% in the pre-update cohort, and 64.7% in the post-update cohort; P <.001). Hypofractionated RT use increased among treated patients over time (P<.001). Boost RT was used in 67.5% of patients, with a decline noted between the pre-update and post-update cohorts (68.7% vs 57.7%; P<.001). Overall RT use as well as use of boost RT were found to be lower among older patients and those with lower-grade or smaller tumors (P<.001), whereas hypofractionated RT was used more commonly in these groups (P<.001).CONCLUSIONS: RT use appears to have declined in elderly patients with ER-positive ESBC, a finding that is reflective of evidence-based practice integrating mature trial data. Further research is needed to develop tools to aid in the decision-making process regarding the delivery or avoidance of RT in this setting. EMTREE DRUG INDEX TERMS estrogen receptor (drug analysis) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) partial mastectomy pathology EMTREE MEDICAL INDEX TERMS adjuvant therapy aged breast tumor (radiotherapy) cancer grading cancer staging chemistry decision making female human Kaplan Meier method radiation dose fractionation statistical model treatment outcome very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25810128 (http://www.ncbi.nlm.nih.gov/pubmed/25810128) PUI L606244997 DOI 10.1002/cncr.29377 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.29377 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 114 TITLE Psychological distress, age and salience of physical appearance: Mediator and moderator effects of the BRECONDA web-based decision aid for women considering breast reconstruction following mastectomy AUTHOR NAMES Sherman K. Shaw L. Winch C. Harcourt D. Cameron L. Brown P. AUTHOR ADDRESSES (Sherman K.; Shaw L.; Winch C.) Macquarie University, Bristol, United Kingdom. (Harcourt D.) University of the West of England, Bristol, United Kingdom. (Cameron L.; Brown P.) University of California, Merced, United States. CORRESPONDENCE ADDRESS K. Sherman, Macquarie University, Bristol, United Kingdom. SOURCE Psycho-Oncology (2015) 24 SUPPL. 2 (44). Date of Publication: July 2015 CONFERENCE NAME 2015 World Congress of Psycho-Oncology CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-07-28 to 2015-08-01 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND/PURPOSE: Women requiring mastectomy for breast cancer are faced with difficult decisions regarding whether, and how, to restore breast shape after surgery. We developed a web-based interactive decision aid, BRECONDA, to assist women with this decision making. Using data from the BRECONDA randomized controlled trial (RCT), this study examined moderators and mediators of decisional conflict and decisional regret. METHODS: Women diagnosed with breast cancer (N= 265) were recruited into the web-based RCT. Participants completed baseline questionnaires and were randomly assigned to either the BRECONDA Intervention (INT) or Usual Care (CONT) conditions. Age and psychological distress at study entry were assessed as moderators, and values about minimizing additional surgical intervention and physical appearance-related concerns were assessed as mediators of BRECONDA. Decisional conflict and decisional regret were assessed at 1- and 6-month follow-up. RESULTS: Linear mixed effects models demonstrated a moderating effect of age and cancer-specific distress on decisional conflict: INT participants who were older and more distressed demonstrated the greatest reduction in decisional conflict at 1- and 6-month follow-up. Mediation bootstrapping analysis revealed that participant values about physical appearancerelated concerns at 1-month follow-up mediated the impact of BRECONDA on decisional conflict and regret at 6-month follow-up. CONCLUSIONS: This is the first RCT to assess a fully integrated online decision aid that incorporates values clarification exercises in the breast reconstruction context. These findings delineate the characteristics of individuals most likely to benefit from the BRECONDA decision aid and a mechanism by which the intervention demonstrates decisional process benefits to women considering breast reconstruction. Research Implications: Prior research has identified the efficacy of the BRECONDA intervention in reducing decisional conflict and decisional regret in women faced with the breast reconstruction decision. These findings delineate the characteristics of individuals most likely to benefit from the BRECONDA decision aid and a mechanism by which the intervention facilitates the decision-making process. Older women, who are typically less extensive users of the Internet, and those experiencing greater levels of cancer-specific distress at the point of study entry, have particularly benefitted from the provision of quality, structured information concerning breast reconstruction options. The mediating effect of attitudinal change regarding the relative importance of physical appearance-related values when considering breast reconstruction highlights the key role of these views when making these surgical decisions. Practice Implications: Online patient resources such as BRECONDA have the advantage of easy accessibility, particularly with increasing Internet access across the broad population. These data support the use of this decisional support resource in oncological surgery practice and identify individuals for whom provision of this resource should be highly recommended and emphasized. The easy-to-use self-guided format of the intervention will allow surgeons to refer their patients to this resource as an adjunct to medical consultations and to facilitate the decision-making process concerning both immediate and delayed breast reconstruction surgery following mastectomy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction distress syndrome female human mastectomy oncology EMTREE MEDICAL INDEX TERMS bootstrapping breast breast cancer consultation decision making exercise follow up Internet model neoplasm patient plastic surgery population questionnaire randomized controlled trial surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71967879 DOI 10.1002/pon.3873 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3873 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 115 TITLE Developing and pilot testing a web-based genetic testing decision aid for young women diagnosed with early-stage breast cancer: A protocol AUTHOR NAMES Foster C. Recio-Saucedo A. Grimmett C. Cutress R. Copson E. Eccles D. Evans G. Gerty S. Armstrong A. Turner L. Mason S. Ahmed M. Eccles B. AUTHOR ADDRESSES (Foster C.; Recio-Saucedo A.; Grimmett C.; Cutress R.; Copson E.; Eccles D.; Turner L.; Mason S.; Ahmed M.; Eccles B.) University of Southampton, United Kingdom. (Evans G.) University of Manchester, United Kingdom. (Gerty S.) Southampton General Hospital, United Kingdom. (Armstrong A.) Christie NHS Foundation Trust, United Kingdom. CORRESPONDENCE ADDRESS C. Foster, University of Southampton, United Kingdom. SOURCE Psycho-Oncology (2015) 24 SUPPL. 2 (288). Date of Publication: July 2015 CONFERENCE NAME 2015 World Congress of Psycho-Oncology CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-07-28 to 2015-08-01 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND/PURPOSE: Younger women diagnosed with breast cancer are more likely to have inherited a mutation in a breast cancer susceptibility gene. Despite modern treatment, younger women are more likely to die from breast cancer than older women. Treatment directed genetic testing at the time of diagnosis is not standard practice but is becoming more common in the UK. Genetic testing has far reaching implications for women identified as gene carriers, such as deciding whether or not to have risk-reducing bilateral mastectomy. However, information about genetic testing aimed specifically at these women is often unavailable outside of specialist regional genetics services. Information to support treatment decisions has been identified as a priority for research in familial breast cancer. METHODS: Informed by the MRC guidance for developing and evaluating complex interventions we will conduct a meta-synthesis of empirical literature to systematically collate information about genetic testing at the time of diagnosis. In-depth semi-structured interviews with 30 young women with early-stage breast cancer and an online survey of health professionals will help inform the content of the decision aid. A prototype will be developed in collaboration with patients, health professionals and academics. Focus groups and think aloud interviews with patients will further refine the tool. RESULTS: A decision aid to support decision making about genetic testing at breast cancer diagnosis will be developed CONCLUSIONS: Development of a Web-based decision aid will provide women with the additional support they require when making a choice about whether or not to have genetic testing at the time of diagnosis. Research Implications: This study will synthesise the literature regarding decision-making tools for young women considering genetic testing as the point of breast cancer diagnosis. It will also provide novel data on clinicians' attitudes towards such testing, as well as the informational needs of women Practice Implications: It is hoped that the new decision aid will enhance understanding, reduce uncertainty and support joint decision making by outlining the risks and benefits of genetic testing that are not yet available for this group. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female genetic screening human oncology EMTREE MEDICAL INDEX TERMS cancer diagnosis cancer susceptibility decision making diagnosis gene genetics health practitioner information processing interview mastectomy medical specialist mutation patient risk semi structured interview synthesis United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71968322 DOI 10.1002/pon.3874 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3874 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 116 TITLE Prophylactic mastectomy decision-making: What help do women need? AUTHOR NAMES Patenaude A.F. AUTHOR ADDRESSES (Patenaude A.F.) Dana-Farber Cancer Institute, United States. CORRESPONDENCE ADDRESS A.F. Patenaude, Dana-Farber Cancer Institute, United States. SOURCE Psycho-Oncology (2015) 24 SUPPL. 2 (17). Date of Publication: July 2015 CONFERENCE NAME 2015 World Congress of Psycho-Oncology CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-07-28 to 2015-08-01 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND/PURPOSE: Women who carry a BRCA1/2 mutation are advised to consider prophylactic mastectomy (PM), which has the potential impact of reducing their high inherited risk of breast cancer by over 90%. Little guides women about how to make such a monumental, body- and life-altering decision. We review the major issues which confound women and provide advice for mental health professionals supporting women of various ages making this important decision. METHODS: Analysis of coded narratives from women interviewed retrospectively because they had undergone PM and review of clinical consultation notes from >25 sessions with women who carry BRCA1/2 mutations seen for psychological consultation as part of their decision making revealed categories of concern in several areas. RESULTS: Consultation/concern focused on discussion of family history of breast cancer and especially deaths from breast cancer, trust in/fears about the efficacy of screening and levels of anxiety experienced in relation to screening, concern about survival to raise young children, level of psychological investment of the woman in her breasts, anticipated sexual impact, body image, and/or family coercion. Angelina Jolie's revelations had varied but significant effects on women's thinking about prophylactic mastectomy. CONCLUSIONS: Professional consultation helps women with decision making about and preparation for prophylactic mastectomy. Peer consultation can be useful if matching parameters are carefully considered. Research Implications: Longitudinal study of decision making and subsequent psychological outcomes would be advantageous. Practice Implications: While discussion of the underlying research about survival advantages of PM is important for some women, equanimity about the decision being one which is medically respected regardless of what is chosen is also important to convey. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making female human mastectomy oncology EMTREE MEDICAL INDEX TERMS anxiety body image breast breast cancer child consultation death family history health practitioner investment longitudinal study mental health mutation narrative parameters persuasive communication risk screening survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71967829 DOI 10.1002/pon.3873 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3873 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 117 TITLE Designing a web-based decision aid: Information requirements of young women diagnosed with early-stage breast cancer AUTHOR NAMES Recio-Saucedo A. Gerty S. Cutress R. Eccles D. Foster C. AUTHOR ADDRESSES (Recio-Saucedo A.; Cutress R.; Eccles D.; Foster C.) University of Southampton, United Kingdom. (Gerty S.) Southampton General Hospital, United Kingdom. CORRESPONDENCE ADDRESS A. Recio-Saucedo, University of Southampton, United Kingdom. SOURCE Psycho-Oncology (2015) 24 SUPPL. 2 (290). Date of Publication: July 2015 CONFERENCE NAME 2015 World Congress of Psycho-Oncology CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-07-28 to 2015-08-01 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND/PURPOSE: Young women who are offered a surgical choice between mastectomy (MRM) and breast-conserving surgery (BCS) for the treatment of early-stage breast cancer face a decision which they may not feel prepared to make. Evidence suggests that treatment associated concerns of younger women differ to those of older women resulting in specific information needs. We report the findings of a qualitative study to determine what types of information young women require at the moment of making a surgical choice. These findings will inform the development of a surgical decision aid to help young women better understand different treatment options and outcomes. METHODS: Thirty-two patients who had a diagnosis of breast cancer ≤40 years old were recruited from three UK hospitals. Information required by women during the time of treatment decision making was identified in twenty in-depth, semi-structured interviews and further explored in two focus groups. RESULTS: Thirty-two women participated in the study. Thirty-seven percent of the women had BCS and 63% MRM, 75% with reconstruction. Information that young women identified as important to support treatment decision making were implications of the different types of breast cancer tumours, cosmetic outcomes of surgery, reconstruction and all aspects related to consequences of clinical and hormonal treatments. Areas identified where information is inadequate included timing and option for reconstructive surgery, effects of treatment on fertility and genetic predisposition. CONCLUSIONS: Information resources tailored for young women which considers agerelated information to support surgical treatment decisions for breast cancer are required and would be supportive to this group. Research Implications: This research suggests that young women have specific information needs, not met by currently available resources. Evidence-based tools to support such decision making must be developed and tested. Practice Implications: Providing such a Web-based decision tool will help young women make difficult choices regarding surgical treatment. Such a resource could be used in the clinical setting to supplement information provided by the clinical team. It is hoped this will enable women to fill adequately informed and thus reduce decisional conflict. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female human oncology EMTREE MEDICAL INDEX TERMS decision making diagnosis evidence based practice fertility genetic predisposition hospital information processing mastectomy partial mastectomy patient plastic surgery qualitative research semi structured interview surgery United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71968325 DOI 10.1002/pon.3874 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3874 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 118 TITLE Treatment decision making in breast cancer: The priorities and psychosocial needs of women across the life span AUTHOR NAMES Campbell-Enns H. Woodgate R. Chochinov H. Medved M. AUTHOR ADDRESSES (Campbell-Enns H.; Woodgate R.; Chochinov H.; Medved M.) University of Manitoba, Canada. CORRESPONDENCE ADDRESS H. Campbell-Enns, University of Manitoba, Canada. SOURCE Psycho-Oncology (2015) 24 SUPPL. 2 (303). Date of Publication: July 2015 CONFERENCE NAME 2015 World Congress of Psycho-Oncology CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-07-28 to 2015-08-01 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND/PURPOSE: For women of all ages, the diagnosis of invasive breast cancer brings with it adversity due to physical concerns and psychosocial challenges. Although much has been learned about the psychosocial impacts of invasive breast cancer, little is known about those impacts on the experience of treatment decision making, or how a woman's age affects her decision making. Patient decision making is crucial to cancer care and, while there is an assumption that patients make these decisions based on clinical parameters, a comprehensive understanding of the contextual considerations that inform these decisions is limited. The purpose of this presentation is to explore the treatment decision-making experience for women with invasive breast cancer across the adult lifespan. METHODS: Data collection and analysis followed the tenants of grounded theory. Semi-structured interviews were conducted with 22 women with invasive breast cancer. The average time from diagnosis was 9.5 months and the average participant age was 55 years (range of 32-80 years). Participants were grouped in three subgroups: younger women, under 45 years (N= 7); middle-aged women, aged 45-64 years (N= 9), and older women, aged 65 and older (N= 6). Interviews were an average of 67 min in length and explored the experience of treatment decision making through open-ended questions, which sought the details about the context of decision making, the process of decision making, and how a woman's age influences her experience. Data were analyzed using constant comparisons at the individual level, subgroup level and as a whole. Data were organized using ATLAS.ti software. RESULTS: The process of decision making will be described, including: the experience and meaning made of the diagnosis; how, why and when an understanding of the diagnosis and/or treatment plans are developed; and how the values and priorities of individuals shape decision making. Similarities and differences regarding the decision- making priorities and the psychosocial needs of younger, middle-aged and older women will be included. Findings show that women of all ages struggle with decision making and, although the experience may be overwhelming, women see benefit in obtaining sufficient knowledge of their diagnoses, and aspects of potential treatments, prior to initiating treatment. Women with a breast cancer diagnosis have specific supportive care needs in treatment decisionmaking; thus a preliminarymodel of supportive care in decision making will be presented. CONCLUSIONS: It is important for women and healthcare providers to understand how contextual considerations, in addition to clinical parameters, will influence decision making. There is a tentative difference in the priorities and psychosocial needs of younger, middle-aged and older women with breast cancer, as they experience treatment decision making; yet women of all ages may require specialized decision-making support. Research Implications: This study contributes to the body of knowledge in cancer decision making by building a model of support from the patient perspective. Further research is needed to examine the categories of the model in other patient samples, and to explore the use of this model in various illness contexts. Practice Implications: Increased understanding of the patient decision-making process, as well as opportunities to provide necessary support in decision making, may improve the patient experience and provide enhanced quality of life for women of all ages with breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision making female human lifespan oncology EMTREE MEDICAL INDEX TERMS adult cancer diagnosis diagnosis diseases grounded theory health care personnel information processing interview middle aged model neoplasm parameters patient patient decision making quality of life semi structured interview software LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71968349 DOI 10.1002/pon.3874 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3874 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 119 TITLE Benefits and risks of contralateral prophylactic mastectomy in women undergoing treatment for sporadic unilateral breast cancer: a decision analysis AUTHOR NAMES Lester-Coll N.H. Lee J.M. Gogineni K. Hwang W.-T. Schwartz J.S. Prosnitz R.G. AUTHOR ADDRESSES (Lester-Coll N.H., nataniel.lester-coll@yale.edu) Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States. (Lee J.M.) Department of Radiology, University of Washington, Seattle, United States. (Gogineni K.; Schwartz J.S.) Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States. (Hwang W.-T.) Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States. (Prosnitz R.G.) The John and Dorothy Morgan Cancer Center, Lehigh Valley Health Network, Allentown, United States. CORRESPONDENCE ADDRESS N.H. Lester-Coll, Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States. Email: nataniel.lester-coll@yale.edu SOURCE Breast Cancer Research and Treatment (2015) 152:1 (217-226). Date of Publication: 11 Jun 2015 ISSN 1573-7217 (electronic) 0167-6806 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT The rate of contralateral prophylactic mastectomy (CPM) is rising rapidly, despite limited evidence about the procedure’s relative benefits and harms. The objective of this study is to examine the impact of CPM on life expectancy (LE) and quality-adjusted life expectancy (QALE) in women with sporadic unilateral breast cancer. A Markov model was developed to compare 18 hypothetical cohorts of 45-year-old women with newly diagnosed unilateral, sporadic breast cancer treated with or without CPM. The probability of developing distant metastases by American Joint Committee on Cancer stage and molecular subtype was derived from British Columbia Cancer Agency data. Additional model parameters were identified from the medical literature. Sensitivity analyses were performed to examine the impact of plausible variations in key model parameters on results. CPM improved LE in all cohorts (range 0.06–0.54 years). Stage had more effect on LE than subtype (stage I mean, 0.44 years, stage III mean, 0.11 years). However, after adjusting for quality-of-life, No CPM was favored in all cohorts. Univariate sensitivity analysis demonstrated that the most influential model parameter was the post-CPM health state utility. The preferred strategy shifted from No CPM to CPM when the post-CPM utility exceeded 0.83 (base case value 0.81). PSA indicated that LE gains and QALE decreases were stable in all cohorts. The primary determinant of survival after unilateral breast cancer is stage at diagnosis. Our results suggest that routine CPM would not improve quality-adjusted survival for the majority of women with unilateral sporadic breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) contralateral prophylactic mastectomy mastectomy risk benefit analysis EMTREE MEDICAL INDEX TERMS analysis article cancer mortality cancer staging cancer survival decision analysis distant metastasis female human life expectancy Markov decision analytic model model overall survival priority journal quality adjusted life expectancy quality of life sensitivity analysis survival time EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015121325 MEDLINE PMID 26062750 (http://www.ncbi.nlm.nih.gov/pubmed/26062750) PUI L604830976 DOI 10.1007/s10549-015-3462-8 FULL TEXT LINK http://dx.doi.org/10.1007/s10549-015-3462-8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 120 TITLE Do patients use decision and communication aids as prompted when meeting with breast cancer specialists? AUTHOR NAMES Volz S. Moore D.H. Belkora J.K. AUTHOR ADDRESSES (Volz S.; Moore D.H.; Belkora J.K.) Institute for Health Policy Studies, University of California, San Francisco, NC, USA SOURCE Health expectations : an international journal of public participation in health care and health policy (2015) 18:3 (379-391). Date of Publication: 1 Jun 2015 ISSN 1369-7625 (electronic) ABSTRACT BACKGROUND: Our breast cancer clinic promotes patient use of decision and communication aids (DAs/CAs) through two mechanisms: coaching and prompting. From January through September 2010, we provided services to 462 of 1106 new visitors (42%). Of those 462 visitors, 267 (58%) received coaching. For the remainder (195 or 42%), the best we could do was prompt them to self-administer the DA and CAs.OBJECTIVE: We wanted to learn whether patients prompted to use DAs/CAs did so.METHODS: We surveyed prompted patients after their visits. We asked how much of each DA they reviewed, whether they listed questions, made notes and audio-recorded their consultations. We tallied frequencies and explored associations using logistic regression.RESULTS: Of the 195 prompted patients, 82 responded to surveys (42%). Nearly all (66/73 or 90%) reported reviewing some or all of the booklets and 52/73 (71%) reported viewing some or all of the DVDs. While 63/78 (81%) responded that they wrote a question list, only 14/61 (23%) said they showed it to their doctor. Two-thirds (51/77 or 66%) said someone took notes, but only 16/79 (20%) reported making audio recordings.DISCUSSION: More patients reported following prompts to use DAs than CAs. Few reported showing question lists to physicians or recording their visits. Our exploratory analyses surfaced associations between using CAs and race/ethnicity or education that merit further investigation.CONCLUSION: Prompting patients assures better use of decision than communication aids. Clinicians may need to take a more active role to ensure patients receive adequate notes and recordings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system doctor patient relation psychology EMTREE MEDICAL INDEX TERMS breast tumor (therapy) female human interpersonal communication middle aged oncology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23294338 (http://www.ncbi.nlm.nih.gov/pubmed/23294338) PUI L612000040 DOI 10.1111/hex.12042 FULL TEXT LINK http://dx.doi.org/10.1111/hex.12042 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 121 TITLE Evaluation of the benefits of breast reconstruction information evenings AUTHOR NAMES Cookson S. Cawrse N. Olsen S. AUTHOR ADDRESSES (Cookson S.; Cawrse N.; Olsen S.) Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. CORRESPONDENCE ADDRESS S. Cookson, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S77). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Women considering breast reconstruction face many difficult choices. Breast reconstruction information evenings were initiated at the Royal Devon & Exeter Hospital (RD&E) in 2011 to provide information and peer support for women considering breast reconstruction. They are facilitated by the Breast Reconstruction Nurse Specialist and supported by medical and nursing staff. Information evenings are held three times a year at the local cancer support centre and are advertised in advance. The aim of the audit was assess the value of peer support and the benefit of providing information in a group setting. Method: Questionnaires were handed out to all women at consecutive information evenings between July 2011 and November 2014. The audit was based on the standard hospital design for auditing support groups. Results: 10 meetings have been held at the RD&E attended by a total of 171 women. The response rate was 58%. (100/171) 100% (100) of respondents would recommend the evening to other women considering breast reconstruction. 90% (90) women valued meeting and talking to the patient volunteers and seeing the results of surgery. 80% (80) women valued talking to healthcare professionals in this setting. 60% (60) women felt the evening supported their decision to go ahead with breast reconstruction. Conclusions: Women value peer support from women who have already had a breast reconstruction. This may help in their decision making. Women valued the opportunity to talk to healthcare professionals. Providing information on breast reconstruction in this format has been well received. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery EMTREE MEDICAL INDEX TERMS clinical audit decision making female health care personnel hospital hospital design human medical specialist neoplasm nurse nursing staff patient peer group questionnaire support group surgery volunteer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214451 DOI 10.1016/j.ejso.2015.03.220 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.220 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 122 TITLE Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program AUTHOR NAMES Belkora J. Volz S. Loth M. Teng A. Zarin-Pass M. Moore D. Esserman L. AUTHOR ADDRESSES (Belkora J., Jeff.belkora@ucsf.edu; Volz S., Shelley.volz@ucsf.edu; Loth M., Meredith.Loth@gmail.com; Teng A., Alexandra.Teng@ucsf.edu; Zarin-Pass M., Margot.Zarin-Pass@ucsf.edu) Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA (Moore D., dmoore@cc.ucsf.edu) Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA (Esserman L., Laura.Esserman@ucsf.edu) Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero Street, 2nd Floor, San Francisco, CA, 94115, USA SOURCE BMC health services research (2015) 15 (209). Date of Publication: 28 May 2015 ISSN 1472-6963 (electronic) ABSTRACT BACKGROUND: Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic.METHODS: From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions.RESULTS: 1. Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80%); coached 1,110 (73%) in the self-administered use of decision and communication aids; sent 958 (63%) decision aids; and directly administered communication aids for 419 (27%) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81% of visits 2. Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction 3. Adoption: Among visitors sent decision aids, 82% of survey respondents reviewed some or all; among those administered communication aids, 86% reviewed one or more after the visit 4.IMPLEMENTATION: Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29% in 2005 to 84% in 2012 5. Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by testing a service learning model in which student interns work as program coaches in exchange for academic credit rather than salary. The feasibility test succeeded, and we are now expanding the use of unpaid interns.CONCLUSION: We have sustained a clinic-wide implementation of decision and communication aids through a novel staffing model that uses paid and unpaid student interns as coaches. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making decision support system education interpersonal communication procedures EMTREE MEDICAL INDEX TERMS adult breast tumor (therapy) California evaluation study female health care personnel human male middle aged patient education program evaluation questionnaire LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26017564 (http://www.ncbi.nlm.nih.gov/pubmed/26017564) PUI L615674127 DOI 10.1186/s12913-015-0872-6 FULL TEXT LINK http://dx.doi.org/10.1186/s12913-015-0872-6 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 123 TITLE Decision analysis of contralateral prophylactic mastectomy for women with sporadic, unilateral, early-stage breast cancer AUTHOR NAMES Davies K.R. Brewster A.M. Parker P.A. Bedrosian I. Crosby M. Peterson S.K. Shen Y. Volk R.J. Cantor S.B. AUTHOR ADDRESSES (Davies K.R.; Brewster A.M.; Parker P.A.; Bedrosian I.; Crosby M.; Peterson S.K.; Shen Y.; Volk R.J.; Cantor S.B.) University of Texas, MD Anderson Cancer Center, Houston, United States. CORRESPONDENCE ADDRESS K.R. Davies, University of Texas, MD Anderson Cancer Center, Houston, United States. SOURCE Journal of Clinical Oncology (2015) 33:15 SUPPL. 1. Date of Publication: 20 May 2015 CONFERENCE NAME 2015 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2015-05-29 to 2015-06-02 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: An increasing number of women with sporadic, unilateral, early-stage breast cancers are choosing to undergo contralateral prophylactic mastectomy (CPM). The aim of this study was to compare overall survival outcomes between CPM and no CPM with continued surveillance following treatment of a primary breast cancer to assist clinical decision-making. Methods: We created an individual-based, state-transition Markov model. We considered women treated for sporadic stage I, II, or III, estrogen receptor (ER) positive and ER-negative breast cancer at ages 40, 50, 60, and 70. To simulate overall survival outcomes for breast cancer patients, we implement an initial 10-year risk period for the development of contralateral breast cancer (CBC) and mortality from the primary or CBC following treatment for the primary and CBC. We incorporated adjustments for mortality probabilities to account for time since treatment for the primary cancer and/or a CBC. Microsimulation trials estimated the average life expectancy (LE) for each strategy. Results: The incremental benefit of CPM compared to no CPM ranged from 0.03 to 0.22 years for women with stage I breast cancer, 0.06 to 0.21 years for stage II, and 0.01 to 0.15 for stage III breast cancer. Greater gains in LE were observed for women < 60 and for stage I, ER-negative cancer; however, the differences were not statistically significant. Sensitivity analysis on LE benefit resulted in a maximum LE difference of 0.37 year for a 40-year-old woman with stage I breast cancer and varying annual risk of CBC. Conclusions: Microsimulation modeling results suggest that CPM provides marginal LE gains for women with early stage breast cancer. The gains in LE decreased with increasing patient age and stage and there was no significant LE gain for ER-positive or ER-negative breast cancer for women ages 50-70. The impact of these results on shared decision making about CPM is an area of active investigation. EMTREE DRUG INDEX TERMS estrogen receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast cancer female human mastectomy oncology society EMTREE MEDICAL INDEX TERMS cancer patient clinical decision making decision making life expectancy model mortality neoplasm overall survival patient primary tumor risk sensitivity analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72011021 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 124 TITLE Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis AUTHOR NAMES Jueckstock J. Kasch F. Jaeger B. Schramm A. Janni W. Scholz C. AUTHOR ADDRESSES (Jueckstock J., julia.jueckstock@med.uni-muenchen.de) Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Campus Innenstadt, Maistr. 11, Munich, Germany. (Kasch F.) Department of Cardiology, Klinikum Hamburg-Harburg, Hamburg, Germany. (Jaeger B.; Schramm A.; Janni W.; Scholz C.) Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany. CORRESPONDENCE ADDRESS J. Jueckstock, Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Campus Innenstadt, Maistr. 11, Munich, Germany. SOURCE Archives of Gynecology and Obstetrics (2015) 292:5 (1101-1107). Date of Publication: 3 May 2015 ISSN 1432-0711 (electronic) 0932-0067 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Purpose: Decisions on the type of adjuvant treatment in older breast cancer patients are challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty on the basis of studies usually excluding patients over 69 years. To aid this decision, we analyzed a database of 6000 unselected patients and of those evaluated elderly primary breast cancer patients with hormone receptor-negative tumors from 1963 until 2003 in respect of survival data depending on adjuvant treatment. Methods: A total of 131 elderly (i.e., >65 years) patients were observed retrospectively for a median of 72 months. Patients received breast-conserving therapy or mastectomy and adjuvant radiotherapy, chemotherapy, and endocrine therapy. Data were collected from a hospital-intern database. Results: Median age at diagnosis was 72 years. Mostly, tumors were small (81 % T1, 17 % T2) but of unfavorable grading (40 % G2, 35 % G3). Lymph nodes were positive in 42 %. Mastectomy was performed in 65 %. While 42 % of patients received radiotherapy, only 10 % were treated with chemotherapy. Patients with G2 and G3 tumors (p = 0.027), younger women (p = 0.012), and patients with positive lymph node status (p < 0.0001) more likely received chemotherapy. Recurrence-free survival was longer in patients without chemotherapy (37 vs. 29 months, p = 0.234). Overall survival was non-significantly shorter in patients who received chemotherapy (59 vs. 81 months, p = 0.131). Conclusions: In this analysis, adjuvant chemotherapy was not associated with improved survival, presumably caused by an a priori poor prognosis of these patients. For an aging society more data are urgently needed to help selecting and personalizing adjuvant treatment within subgroups of breast cancer in older women. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy, surgery) cancer adjuvant therapy EMTREE MEDICAL INDEX TERMS aged article cancer grading cancer hormone therapy cancer patient cancer radiotherapy cancer survival controlled study female geriatric patient human human tissue lymph node metastasis major clinical study mastectomy overall survival primary tumor recurrence free survival retrospective study tumor volume EMBASE CLASSIFICATIONS Cancer (16) Gerontology and Geriatrics (20) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015032433 MEDLINE PMID 25935195 (http://www.ncbi.nlm.nih.gov/pubmed/25935195) PUI L604329794 DOI 10.1007/s00404-015-3728-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00404-015-3728-8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 125 TITLE Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy AUTHOR NAMES Harvey J.R. Bundred N.J. Kirwan C.C. Gandhi A. Duxbury P.J. AUTHOR ADDRESSES (Harvey J.R.; Bundred N.J.; Kirwan C.C.; Gandhi A.; Duxbury P.J.) CORRESPONDENCE ADDRESS J.R. Harvey, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Approximately 30-40% of women are not offered immediate breast reconstruction because the possibility of post-mastectomy radiotherapy (PMRT) is unknown at the time of mastectomy. Breast reconstruction may be delayed until final pathology is available and need for radiotherapy established. Surgical literature is replete with studies of varying quality, reporting complication rates for a range of reconstructive procedures, highlighting the need for surgical trials of reconstructive techniques in women at risk of PMRT. Decisions for these patients are complex, involving multiple clinicians including surgeons and oncologists. To inform a surgical trial design, we aimed to determine current UK surgical practice and gain an understanding of the drivers behind decision-making. Methods: A questionnaire, validated in a pilot population, was posted to Consultant members of the Association of Breast Surgery (UK). We collected data on current practice in conducting Delayed, Immediate and Delayed-immediate reconstructive surgery. We collated data on type and volume of procedure performed and factors affecting decision-making including delay to adjuvant treatment, risk of complications, perception of patients' quality of life (QoL) and aesthetic satisfaction. Results: Of 355 surgeons, 130(37%) responded. Of these, 77% felt the current evidence base was not adequate to guide surgical decisions and 80% felt a need for further trials to guide best treatment. Despite a lack of scientific evidence demonstrating a difference in cosmesis or QoL between Immediate and Delayed reconstruction, 85% felt there is not equivalent cosmesis and 71% felt there is not equivalent QoL between the two groups. There is considerable heterogeneity in reconstructive approach to patients at risk of PMRT (Table 1). Delayed reconstruction remains the most popular option, being regularly used by 94% of surgeons despite only 34% of surgeons believing the majority of patients are satisfied with the approach. Significantly fewer surgeons perform Immediate implant based reconstruction (with or without ADM) than Delayed (p<0.01). Implant reconstruction is performed by 71% of surgeons in patients at risk of PMRT, but only 44% of surgeons felt patients were happy with the final results. The three most important drivers in making a reconstructive choice were 1. Effect of PMRT on the cosmetic result 2. Minimising risk of complications and avoiding delay to adjuvant treatment 3. Pre-operative uncertainty over the need for PMRT. Conclusions: Surgeons employ a variety of approaches to reconstruction in the face of PMRT, the most common approach being delayed reconstruction. Decision-making is based upon individual surgeon's perception of risks including likely delay to adjuvant therapy and effect of PMRT on the reconstruction. Drivers appeared to be more surgeon-centred rather than patient-based. There is awareness of a lack of evidence to support decision-making and the need for high quality studies. Randomised clinical trials are needed to provide an evidence base for outcomes. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy radiotherapy United Kingdom EMTREE MEDICAL INDEX TERMS adjuvant therapy breast reconstruction breast surgery clinical trial (topic) consultation decision making female human implant oncologist pathology patient plastic surgery population procedures quality of life questionnaire risk satisfaction study design surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929509 DOI 10.1158/1538-7445.SABCS14-P2-14-09 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-14-09 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 126 TITLE A cost-utility analysis comparing the plasmablade to thermal cautery in mastectomies AUTHOR NAMES Chatterjee A. Chen L. Czerniecki B. Tchou J. Fisher C. AUTHOR ADDRESSES (Chatterjee A.; Czerniecki B.; Tchou J.; Fisher C.) Surgery, University of Pennsylvania, Philadelphia, United States. (Chen L.) Surgery, Lahey Clinic, Burlington, United States. CORRESPONDENCE ADDRESS A. Chatterjee, Surgery, University of Pennsylvania, Philadelphia, United States. SOURCE Annals of Surgical Oncology (2015) 22:2 SUPPL. 1 (42-43). Date of Publication: May 2015 CONFERENCE NAME 16th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2015-04-29 to 2015-05-03 ISSN 1068-9265 BOOK PUBLISHER Springer New York LLC ABSTRACT Objective In our evolving health care system, breast surgeons face increasing cost containment pressures while being held to a high standard of quality care. New forms of alluring surgical technology constantly arise but the adoption of more expensive technology often requires a cost justification. Cost utility analysis empowers the surgeon to potentially justify the cost-effectiveness of a technology by not only analyzing the costs but also weighing the clinical importance of a newer device over the status quo. To demonstrate cost-utility analysis in breast surgery, our goal was to perform a cost-utility analysis to see if the PlasmaBlade was cost-effective when performing a mastectomy when compared to standard thermal cautery. Methods Cost-utility methodology involved a literature review compiling outcomes for mastectomies done with either the PlasmaBlade or thermal cautery, obtaining utility scores for complications to estimate quality-adjusted life years (QALYs), accruing costs using DRG and CPT codes for each intervention, and developing a decision tree that could portray the more cost-effective strategy. Mastectomy complications were limited to those specifically related to the use of either device. An incremental cost utility ratio (ICUR) was calculated from the ratio of cost differences over clinical effectiveness differences between each device. The upper limit for willingness to pay was set at $50,000. Sensitivity analysis was performed to check the robustness of our results. Results Based on the literature review, the PlasmaBlade arm had a lower overall complication rate (12.5%), compared to the thermal cautery arm (18.1%). Surprisingly, there were no reported differences in mastectomy skin necrosis. The cost of the PlasmaBlade per mastectomy case was more ($300), compared to the cost of a cautery tip ($4). The decision analysis tree (Figure 1) noted outcomes with their associated costs for each treatment arm and found that the PlasmaBlade was more costly by an incremental $156.98 and had an improved clinical efficacy of 0.0045 QALYs leading to a cost-effective ICUR of $34,577.31/QALY. One-way sensitivity analysis revealed that the PlasmaBlade was cost-effective up to a pricing of $370 per mastectomy case. Conclusion Based on outcomes gathered from the literature, which were then valued in a decision tree analysis, the PlasmaBlade is a cost-effective technology compared to thermal cautery when used in mastectomies. It remains cost-effective up to a cost of $370 per mastectomy case. (Figure Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast cauterization cost utility analysis human mastectomy society surgeon EMTREE MEDICAL INDEX TERMS arm breast surgery clinical effectiveness cost control cost effectiveness analysis Current Procedural Terminology decision tree devices health care system methodology quality adjusted life year sensitivity analysis skin necrosis surgical technology technology tree LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71949166 DOI 10.1245/s10434-015-4561-9 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-015-4561-9 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 127 TITLE onlineDeCISion.org: An interactive web-based clinical decision aid for DCIS treatment AUTHOR NAMES Ozanne E.M. Stout N.K. Schneider K. Soeteman D. Schrag D. Fordis M. Punglia R.S. AUTHOR ADDRESSES (Ozanne E.M.; Stout N.K.; Schneider K.; Soeteman D.; Schrag D.; Fordis M.; Punglia R.S.) CORRESPONDENCE ADDRESS E.M. Ozanne, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Purpose: Treatment decisions regarding Ductal Carcinoma in Situ (DCIS) are complex, and patients often have inaccurate and incomplete understanding of the risks and benefits they face. Our objective was to create a web-based decision aid (onlineDeCISion.org) that can be used in clinical practice to guide both clinicians and their patients with these decisions. Methods: We developed a web-based clinical decision aid to provide tailored information about DCIS treatment choices including an individual patient's risk of recurrence, likelihood of long-term breast preservation and survival outcomes following up to 6 different treatment strategies for DCIS (lumpectomy, lumpectomy with radiation, lumpectomy with tamoxifen, lumpectomy with radiation and tamoxifen, and mastectomy with or without breast reconstruction). The decision aid is populated by our previously developed simulation model of DCIS outcomes. A theoretical framework and best-practices for web-based decision tools guided the development of the decision aid including semi-structured interviews and usability testing with a diverse group of multidisciplinary clinicians and patient advocates. Results: The decision aid was designed to include these key features: 1) descriptions of treatment options; 2) ability to input patient health-adjusted age; 3) tailored likelihood of time-specific (10-year and lifetime) recurrence and survival outcomes; and 4) projections of downstream effects of each treatment. The decision aid provides default recurrence risks based on clinical trial data but allows clinicians to customize 10-year DCIS and invasive recurrence risks to retain flexibility to display expected outcomes for individual patients. These estimates can be based on the patient's actual age, or age adjusted for health status, allowing for a more realistic expectation of the benefits each treatment holds. Conclusion: Our web-based decision aid displays tailored outcomes following different treatment strategies for DCIS, allowing patients to be better informed about the tradeoffs of treatments available to them and select treatments consonant with their personal preferences, improving the quality of decision making for DCIS. The interactive design features allow users of the decision aid the ability to address uncertainty around risks of recurrence and comorbidity risks and facilitate the use of the decision aid across diverse populations. While the decision aid warrants further evaluation, the results of our study promise to improve decision making in patients with DCIS. EMTREE DRUG INDEX TERMS tamoxifen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer intraductal carcinoma EMTREE MEDICAL INDEX TERMS breast breast reconstruction clinical practice clinical trial comorbidity conceptual framework consonant decision making health health status human lifespan mastectomy partial mastectomy patient patient risk population preservation radiation recurrence risk risk semi structured interview simulation survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71928779 DOI 10.1158/1538-7445.SABCS14-P2-10-01 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-10-01 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 128 TITLE Contralateral prophylactic mastectomy: Patient preferences and risk perceptions AUTHOR NAMES Partridge A. AUTHOR ADDRESSES (Partridge A.) CORRESPONDENCE ADDRESS A. Partridge, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Recent studies have revealed increasing rates of contralateral prophylactic mastectomy (CPM) among women with unilateral early stage breast cancer. Bilateral mastectomy at diagnosis of unilateral breast cancer is particularly common among young women, with younger age consistently identified as a predictor of CPM. This trend for more surgery rather than less has raised concerns, given the lack of evidence for a survival benefit from CPM and the relatively low risk of contralateral breast cancer for most women in this setting. Although mastectomy is a safe procedure and major complications are rare, there are potential negative consequences including cosmetic concerns and clinically significant potential long-term sequelae such as numbness of the chest skin and chronic pain and decreased function. Given most women opt for reconstructive surgery, extended recovery time, additional surgical complications, and decreased strength or function due to muscles being moved or stretched are also additional risks. Recent data have revealed that some women who undergo CPM have misperceptions about their actual risks and the values of the prophylactic surgery. In a recent cross-sectional survey of young breast cancer survivors who had undergone bilateral mastectomy for unilateral breast cancer, most women indicated that desire to decrease their risk for contralateral breast cancer (98%) and improve survival (94%) were extremely or very important factors in their decision to have CPM. However, only 18% indicated that women with breast cancer who undergo CPM live longer than those who do not. BRCA1 or BRCA2 mutation carriers more accurately perceived their risk for contralateral breast cancer, whereas women without a known mutation substantially overestimated this risk. An increasing body of literature suggests that fear of recurrence and anxiety are strong predictors of undergoing CPM. Improved education and counseling about the risks and benefits of CPM, as well as increased awareness and management of anxiety surrounding breast cancer diagnosis and treatment, are likely to help patients to understand their risks more fully and to make decisions consistent with their preferences and values. Decision aids may be particularly useful in this setting. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer human mastectomy patient preference risk EMTREE MEDICAL INDEX TERMS anxiety cancer diagnosis cancer survivor chronic pain counseling diagnosis education fear female muscle mutation paresthesia patient plastic surgery postoperative complication procedures skin surgery survival thorax LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71928462 DOI 10.1158/1538-7445.SABCS14-CS1-2 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-CS1-2 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 129 TITLE Validation of a software based clinical decision support system for breast cancer treatment in a tertiary care cancer center in India AUTHOR NAMES Nair N. Gupta S. Ramarajan N. Srivastava G. Parmar V. Munshi A. Vanmali S. Vanmali V. Hawaldar R. Badwe R.A. AUTHOR ADDRESSES (Nair N.; Gupta S.; Ramarajan N.; Srivastava G.; Parmar V.; Munshi A.; Vanmali S.; Vanmali V.; Hawaldar R.; Badwe R.A.) CORRESPONDENCE ADDRESS N. Nair, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Access to expert, evidence based clinical decision making is crucial in maximizing the outcome of women with breast cancer, but is a scarce resource, especially in developing countries. The Navya Expert System is a patented, software based clinical decision support system that exhaustively searches and assimilates relevant medical literature and guidelines to make specific therapeutic recommendations for individual patients based on their clinical data. This study is a retrospective validation of Navya Expert System's output against tumor board decisions of a multidisciplinary group of expert breast cancer clinicians working in a tertiary care oncology center in India. Methods: Women with non-metastatic breast cancer who had already completed their loco-regional and systemic therapy based on the recommendations of the tumor board were included in the study. The protocol specified clinical and pathology data of these women were retrospectively abstracted from their case charts and processed through the Navya Expert System. The output was classified into major (neo-adjuvant chemotherapy versus upfront surgery and need for adjuvant chemotherapy, endocrine therapy and radiation therapy, respectively) and minor (breast conservation versus mastectomy, taxane versus non-taxane adjuvant chemotherapy and need for nodal radiation therapy) therapeutic decisions. Decisions discordant between the tumor board and the Navya Expert System were adjudicated by an expert panel of breast cancer clinicians from the same institution. Navya Expert System decisions were classified as discordant with appropriate clinical practice if they were in disagreement with both the tumor board and expert panel. All other Navya Expert System decisions were classified as concordant. The primary outcome of the study was concordance between the Navya Expert System and the tumor board or expert panel for major and minor therapeutic decisions. Results: A total of 76 patients involving 224 major and 224 minor therapeutic decisions were included in the study. Navya Expert System's output was concordant with the tumor board or expert review in 224/224 major decisions (100%, 95% CI 99.6%-100%) and 221/224 minor decisions (98.6%, 95% CI 97.1%-100%). Navya Expert System's output was concordant with the tumor board alone in 210/224 (93.75%, 95% CI 90.6%-96.9%) major decisions and 160/224 (71.4%, 95% CI 65.5%-77.3%) minor decisions. Most common reasons for discordance were non-prescription of HER2 targeted therapy by the tumor board due to financial constraints and non-use of nodal radiation for 1-3 node positive patients. Of the 64/224 Navya Expert System decisions discordant with the tumor board, only 3 were finally deemed discordant after review by the expert panel. Conclusions: Navya Expert System treatment recommendations, only requiring the input of commonly available clinical data, are highly concordant with those of a tumor board comprised of breast cancer experts with high level expertise. If these results can be prospectively validated, Navya Expert System has the potential to increase global access to evidence based clinical decision making in breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer center cancer therapy decision support system India software tertiary health care EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy breast clinical decision making clinical practice clinical study developing country evidence based practice expert system female hormonal therapy human legal evidence mastectomy medical literature metastatic breast cancer neoplasm oncology pathology patient prescription radiation radiotherapy surgery systemic therapy therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929479 DOI 10.1158/1538-7445.SABCS14-P4-16-01 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P4-16-01 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 130 TITLE Decision-making surrounding adjuvant chemotherapy in young women with early stage breast cancer AUTHOR NAMES Rosenberg S.M. Sepucha K. Ruddy K.J. Schapira L. Come S. Borges V. Morgan E. Lin N.U. Gelber S. Tamimi R.M. Partridge A.H. AUTHOR ADDRESSES (Rosenberg S.M.; Sepucha K.; Ruddy K.J.; Schapira L.; Come S.; Borges V.; Morgan E.; Lin N.U.; Gelber S.; Tamimi R.M.; Partridge A.H.) CORRESPONDENCE ADDRESS S.M. Rosenberg, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: There is an increasing recognition that many young women with breast cancer will have favorable outcomes without chemotherapy. We sought to characterize decision-making surrounding adjuvant chemotherapy treatment (CT) in this population for whom chemotherapy has historically been a standard of care. Methods: As part of an ongoing, multi-center, prospective cohort of young women diagnosed with breast cancer at age 40 and younger, we identified 657 women with Stage I-III breast cancer. Participants were asked to complete surveys by mail that included questions about socio-demographics, decision-making, and treatment history within the first year following diagnosis. Tumor characteristics were ascertained via pathology and medical record review. We used Chi-square tests to compare: decisional involvement (patient-driven vs. shared vs. physician-driven), degree of confidence, and feeling informed about the CT decision (the latter two measured on a 0-10 scale, categorized as follows: 0-5=low; moderate=6-8; 9-10=high) between women who did and did not receive CT. To explore clinical appropriateness of the CT decision, we used logistic regression to assess the relationship between tumor characteristics and non-receipt of CT among women with Stage I/II disease. Results: Among women with Stage I (n=250), II (n=312), and III (n=95), disease, 66%, 95%, and 100%, received CT, respectively. A greater proportion of women who had CT were highly confident with their decision compared with women who did not have CT (80% vs. 60%, p<0.0001); women who did not have CT were more likely to report a low level of feeling informed about the CT decision compared to women who received CT (20% vs. 5%, p<0.0001). Women who did not have CT were also more likely to report the final CT decision as made by their doctor (49% vs. 28%) and less likely to report a shared decision (33% vs. 59%, p<0.0001). Non-receipt of CT in women with Stage I/II disease (n=546) was associated within having node negative disease, T1 (vs. T2 or larger), Her2- negative, and hormone receptor positive tumors. Conclusion: Although non-receipt of CT would be expected to be viewed favorably by patients and doctors, we found that women who received CT felt more confident and better informed than those who received no CT. Given that women who did not have CT were also less likely to perceive the CT decision as shared, improved communication together with better decisional support may be beneficial, especially for women who do not receive adjuvant chemotherapy. EMTREE DRUG INDEX TERMS hormone receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant chemotherapy breast cancer decision making female human EMTREE MEDICAL INDEX TERMS chemotherapy chi square test diagnosis health care quality interpersonal communication logistic regression analysis medical record review neoplasm pathology patient physician population LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71928781 DOI 10.1158/1538-7445.SABCS14-P2-10-03 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-10-03 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 131 TITLE Characterizing the metastatic breast cancer patient experience around preparing for a treatment decision AUTHOR NAMES Buzaglo J. Miller M. Morris A. Harvey A. Golant M. AUTHOR ADDRESSES (Buzaglo J.; Miller M.; Morris A.; Harvey A.; Golant M.) CORRESPONDENCE ADDRESS J. Buzaglo, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: An estimated 155,000 people are living with metastatic breast cancer (MBC) in the US. With new developments in treatment, people are living longer with MBC and are confronted with more complex treatment decisions. Patient-provider communication is typically inadequate and patients are not fully prepared for communicating effectively with their doctor. Methods: Since March 2013, the Cancer Support Community has registered 909 people living with MBC to the Cancer Experience Registry, an online initiative designed to learn and raise awareness about the psychosocial impact of cancer. 572 registrants responded to questions about their experience with making treatment decisions. This sample was 99% female, 91% Caucasian, and 69% with a college degree and median age 56. Median time since MBC diagnosis was 3 years. Results: Before making a treatment decision, nearly all (91%) reported receiving information about their cancer type; 76% received information about their treatment choices. Only 41% indicated they received information about clinical trials prior to making a treatment decision. Just over half reported they had quite a bit of knowledge about their treatment options. However, 22% had little or no knowledge about their treatment options. Thirty-eight percent received treatment decision support prior to making a treatment decision; 45% would have liked more support. Twelve percent had little or no involvement in their treatment decision-making process. Nearly one-third (29%) did not feel they had a treatment choice and 28% reported they did not have enough time to make a treatment decision. Those who wrote down a list of questions prior to their first visit to discuss treatment options with their health care provider felt significantly more prepared to discuss their treatment options (p<0.001). About two-thirds of MBC registrants were satisfied with various aspects of the treatment decision-making process: outcome of the treatment(s) received (70%); doctor's explanation of the benefits of each option (67%); how they arrived at a decision (66%); how much they participated in making the decision (64%); and their doctor's explanation of the risks and side effects (64%). Sixty-nine percent thought it would be important to get help with gathering information, and 68% with developing a written list of questions before their meetings with cancer specialists; only 47% thought it important to obtain audio-recordings of appointments. Conclusion: Although over two thirds of these women were satisfied with various aspects of treatment decision making including their communication and interaction with their doctor around the decision, nearly 30% of women thought that they had no choice or felt rushed in making a decision. Those women who prepared a list of questions prior to a consultation with the doctor were significantly more prepared in making an appropriate decision. While a small majority of patients report being knowledgeable about treatment options, a significant proportion report not having enough knowledge or support to fully engage in a treatment decision. Further efforts are needed to address gaps in the delivery of decision support to MBC patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human metastatic breast cancer EMTREE MEDICAL INDEX TERMS audio recording Caucasian clinical trial (topic) college community consultation decision making decision support system diagnosis female health care personnel interpersonal communication medical specialist neoplasm patient physician register risk side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71928782 DOI 10.1158/1538-7445.SABCS14-P2-10-04 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-10-04 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 132 TITLE Balancing the harms and benefits of radiation therapy for DCIS: A decision analysis examining the risk of radiation-associated sarcoma AUTHOR NAMES Decker M.R. Levy J.F. Wilke L.G. Vanness D.J. Neuman H.B. AUTHOR ADDRESSES (Decker M.R.; Levy J.F.; Wilke L.G.; Vanness D.J.; Neuman H.B.) CORRESPONDENCE ADDRESS M.R. Decker, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT INTRODUCTION: More than 60,000 women are diagnosed with ductal carcinoma in situ (DCIS) annually and offered the option of breast conserving surgery (BCS), often including radiation (RT) to reduce local recurrence. Although the incidence of radiation-associated sarcoma (RAS) is low (0.05-0.25% at 10 years), the low mortality associated with DCIS and large number of DCIS diagnoses means that an increasingly large number of women are at risk of RAS. This study sought to weigh the risk of RAS with the benefits of BCS+RT for DCIS. METHODS: A second-order Monte Carlo micro-simulation model of women ages 35 and older with DCIS was constructed. The decision analysis compared harm-benefit ratios of sarcoma-related deaths per breast cancer deaths averted within 20 years of treatment with BCS+RT versus BCS alone. Stratified analyses were performed by age group to account for differential life expectancy. To generate parameter estimates for model inputs, Bayesian network meta-analysis was used to synthesize rates of DCIS and invasive recurrence from clinical trials of BCS+RT and BCS alone using a Weibull specification. Sarcoma incidence was estimated non-parametrically using SEER. Constant hazard rates for breast cancer mortality after invasive recurrence and RAS mortality were estimated from clinical trials. To account for uncertainty, probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo samples and 95% credible intervals (CrI) were constructed for event rates and harm-benefit ratios. RESULTS: The micro-simulation model of an age-distributed cohort demonstrated that 1 in 840 women with DCIS (95%CrI 1:648 to 1:3522) would develop RAS within 20 years after treatment with BCS+RT. Overall, there would be 1 RAS-related death for every 12 breast cancer deaths averted (95%CrI 1:7 to 1:19) by the addition of RT to BCS. Stratified analysis demonstrated that the harm-benefit ratio was higher in women >75 years of age, with more RAS-related deaths caused per breast cancer deaths averted. The model was most impacted by parameter estimates for rates of invasive recurrence, breast cancer mortality after invasive recurrence, and RAS incidence rates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer intraductal carcinoma radiation radiotherapy risk sarcoma EMTREE MEDICAL INDEX TERMS cancer mortality clinical trial (topic) death diagnosis female groups by age hazard human incidence life expectancy meta analysis model mortality partial mastectomy sensitivity analysis simulation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929308 DOI 10.1158/1538-7445.SABCS14-P6-09-06 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P6-09-06 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 133 TITLE Vascular variations of the transverse upper gracilis flap in consideration for breast reconstruction AUTHOR NAMES Natoli N.B. Wu L.C. AUTHOR ADDRESSES (Natoli N.B.; Wu L.C.) From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA SOURCE Annals of plastic surgery (2015) 74:5 (528-531). Date of Publication: 1 May 2015 ISSN 1536-3708 (electronic) ABSTRACT PURPOSE: The transverse upper gracilis (TUG) myocutaneous flap has served as an alternative to abdominally based autologous breast reconstruction since its introduction by Yousif et al in 1992. The reliability of the overlying skin paddle of the gracilis myocutaneous flap depends on the perforator anatomy as well as the vascular pedicle. Although much attention recently has been given to variations in the septocutaneous as well as myocutaneous perforators, we believe that relevant variations in pedicle anatomy have been underappreciated. We would like to report our experience with pedicle variability.METHODS: A retrospective review of records was performed on patients undergoing a TUG flap for autologous breast reconstruction from July 2006 and November 2011 by a single surgeon (L.C.W.).RESULTS: A total of 36 TUG flaps were performed on 24 patients. Twelve patients underwent bilateral simultaneous TUG reconstruction, and 12 patients underwent unilateral TUG reconstruction. Pedicle variability was found in 6 (17%) of 36 dissections. In 5.5% of dissections, there was a split pedicle and 11% were found to have a double main pedicle. There was 1 partial flap loss that resulted in a failed breast reconstruction. Four limbs had some degree of resultant lymphedema as a consequence of flap harvest.CONCLUSIONS: Although still a viable alternative to abdominally based autologous reconstruction, we find that the variability of the main pedicle has been quite underestimated in earlier reports. We also present a logical algorithm for flap dissection when the microsurgeon encounters such aberrancies. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital malformation procedures vascularization EMTREE MEDICAL INDEX TERMS adult algorithm breast reconstruction case report decision support system female femoral artery human middle aged myocutaneous flap retrospective study surgery thigh LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24401804 (http://www.ncbi.nlm.nih.gov/pubmed/24401804) PUI L607634531 DOI 10.1097/01.sap.0000435501.19566.75 FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000435501.19566.75 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 134 TITLE Contralateral Prophylactic Mastectomy: Anxiety, Knowledge and Shared Decision Making AUTHOR NAMES Bedrosian I. Yao K. AUTHOR ADDRESSES (Bedrosian I., ibedrosian@mdanderson.org) Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. (Yao K., kyao@northsore.org) Pritzker School of Medicine, University of Chicago, Chicago, United States. (Yao K., kyao@northsore.org) Department of Surgery, NorthShore University HealthSystem, Evanston, United States. CORRESPONDENCE ADDRESS I. Bedrosian, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. SOURCE Annals of Surgical Oncology (2015) 22:12 (3767-3768). Date of Publication: 29 Apr 2015 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety contralateral prophylactic mastectomy knowledge mastectomy medical decision making patient decision making prophylactic surgical procedure shared decision making EMTREE MEDICAL INDEX TERMS breast cancer decision support system doctor patient relation editorial emotion fear health care utilization human patient preference second cancer surgeon EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015995644 MEDLINE PMID 25920918 (http://www.ncbi.nlm.nih.gov/pubmed/25920918) PUI L604110621 DOI 10.1245/s10434-015-4573-5 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-015-4573-5 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 135 TITLE Difficult choices for young patients with cancer: the supportive role of decisional counseling AUTHOR NAMES Chiavari L. Gandini S. Feroce I. Guerrieri-Gonzaga A. Russell-Edu W. Bonanni B. Peccatori F.A. AUTHOR ADDRESSES (Chiavari L., leonora.chiavari@gmail.com; Peccatori F.A., fedro.peccatori@ieo.it) Fertility and Procreation in Oncology Unit, European Institute of Oncology, via Ripamonti, 435, Milan, Italy. (Chiavari L., leonora.chiavari@gmail.com; Feroce I., irene.feroce@ieo.it; Guerrieri-Gonzaga A., aliana.guerrierigonzaga@ieo.it; Bonanni B., bernardo.bonanni@ieo.it) Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, Milan, Italy. (Gandini S., sara.gandini@ieo.it) Division of Cancer Prevention and Genetics, European Institute of Oncology, via Ripamonti, 435, Milan, Italy. (Russell-Edu W., william.russell-edu@ieo.it) Library, European Institute of Oncology, via Ripamonti, 435, Milan, Italy. CORRESPONDENCE ADDRESS L. Chiavari, Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, Milan, Italy. Email: leonora.chiavari@gmail.com SOURCE Supportive Care in Cancer (2015) 23:12 (3555-3562). Date of Publication: 11 Apr 2015 ISSN 1433-7339 (electronic) 0941-4355 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Purpose: The aim of patient decisional support interventions is to promote shared decision making. Many of these interventions are comprehensive of information and guidance. In this pilot study, we evaluate the effects of a decision-making support (decision counseling (DeCo)) on decision making, decisional conflict, and anxiety in cancer patients facing with values-based decisions on fertility and procreation or genetic testing and risk reduction options in oncology. Methods: DeCo was proposed during the medical consultation. The following questionnaires were administered to 54 patients before the DeCo session and 1 week after it: stage of decision making (SDM), decisional conflict scale (DCS) and subscales (“uncertainty,” “informed,” ”clarity,” “support,” and “effective decision”), state-trait anxiety inventory. Decision Support Questionnaire and Usefulness of Decision Counseling were created ad hoc for this study. Multivariate logistic models and ANCOVA models were used to investigate the changes of SDM and DCS in association with DeCo. Results: We found a significant improving in SDM with DeCo (P = 0.01) and a significant reduction in DCS with DeCo (P = 0.007) measured with the Decision Support Questionnaire. In particular, the DCS informed subscale showed a significant decrease in time (P = 0.002). Conclusion: DeCo is useful to facilitate decision making and reduce decisional conflict. It plays a role in the perception of being informed while not directly providing clinical information. This model of decisional support intervention, in which information is provided only by the clinician and decisional support is focused on personal aspects that influence the decision, could improve shared decision making between patient and clinicians. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient decision support system fertility preservation patient decision making personal value EMTREE MEDICAL INDEX TERMS adult anxiety article breast cancer conflict female genetic screening human major clinical study male patient counseling pilot study priority journal risk reduction State Trait Anxiety Inventory EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015918125 MEDLINE PMID 25862346 (http://www.ncbi.nlm.nih.gov/pubmed/25862346) PUI L603717262 DOI 10.1007/s00520-015-2726-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00520-015-2726-5 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 136 TITLE Development and piloting of a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 breast cancer trial AUTHOR NAMES Juraskova I. Butow P. Fisher A. Bonner C. Anderson C. Bu S. Scarlet J. Stockler M.R. Wetzig N. Ung O. Campbell I. AUTHOR ADDRESSES (Juraskova I., ilona.juraskova@sydney.edu.au; Butow P.; Fisher A.; Bonner C.; Anderson C.; Bu S.) Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, University of Sydney, Brennan MacCallum (A18), Sydney, Australia. (Scarlet J.; Campbell I.) Breast Cancer Centre, Waikato Hospital, Hamilton, New Zealand. (Stockler M.R.) NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. (Wetzig N.) Princess Alexandra Hospital, Brisbane, Australia. (Ung O.) Royal Brisbane and Women's Hospital, Brisbane, Australia. (Ung O.) Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia. CORRESPONDENCE ADDRESS I. Juraskova, Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, University of Sydney, Brennan MacCallum (A18), Sydney, Australia. Email: ilona.juraskova@sydney.edu.au SOURCE Clinical Trials (2015) 12:4 (409-417). Date of Publication: 1 Apr 2015 ISSN 1740-7753 (electronic) 1740-7745 BOOK PUBLISHER SAGE Publications Ltd, info@sagepub.co.uk ABSTRACT Background/aims: This study aimed to (1) develop a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 (SNAC-2) breast cancer surgical trial and (2) obtain evidence on its acceptability, feasibility, and potential efficacy in routine trial clinical practice via a two-stage pilot. Methods: The decision aid was developed according to International Patient Decision Aid Standards. Study 1: an initial pilot involved 25 members of the consumer advocacy group, Breast Cancer Network Australia. Study 2: the main pilot involved 20 women eligible to participate in the SNAC-2 trial in New Zealand. In both pilots, a questionnaire assessed: information and involvement preferences, decisional conflict, SNAC-2 trial-related understanding and attitudes, psychological distress, and general decision aid feedback. A follow-up telephone interview elicited more detailed feedback on the decision aid design and content. Results: In both pilots, participants indicated good subjective and objective understanding of SNAC-2 trial and reported low decisional conflict and anxiety. The decision aid was found helpful when deciding about trial participation and provided additional, useful information to the standard trial information sheet. Conclusion: The development and two-stage piloting process for this decision aid resulted in a resource that women found very acceptable and helpful in assisting decision-making about SNAC-2 trial participation. The process and findings provide a guide for developing other trial decision aids. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axillary lymph node breast cancer decision support system lymph node dissection patient participation sentinel lymph node biopsy EMTREE MEDICAL INDEX TERMS adult anxiety clinical article clinical trial (topic) conference paper distress syndrome female human New Zealand patient attitude patient decision making patient preference patient satisfaction pilot study priority journal telephone interview EMBASE CLASSIFICATIONS Cancer (16) CLINICAL TRIAL NUMBERS LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015428172 MEDLINE PMID 26033878 (http://www.ncbi.nlm.nih.gov/pubmed/26033878) PUI L606306381 DOI 10.1177/1740774515586404 FULL TEXT LINK http://dx.doi.org/10.1177/1740774515586404 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 137 TITLE The cost effectiveness of the DIEP flap relative to the muscle-sparing TRAM flap in postmastectomy breast reconstruction AUTHOR NAMES Krishnan N.M. Purnell C. Nahabedian M.Y. Freed G.L. Nigriny J.F. Rosen J.M. Rosson G.D. AUTHOR ADDRESSES (Krishnan N.M.; Purnell C.; Nahabedian M.Y.; Freed G.L.; Nigriny J.F.; Rosen J.M.; Rosson G.D.) Hannover and Lebanon, N.H.; Chicago, Ill.; Washington, D.C.; and Baltimore, Md. From the Geisel School of Medicine at Dartmouth; the Division of Plastic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center; the Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine; the Department of Plastic Surgery, Georgetown Hospital; and the Department of Plastic Surgery, Johns Hopkins University School of Medicine SOURCE Plastic and reconstructive surgery (2015) 135:4 (948-958). Date of Publication: 1 Apr 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: The deep inferior epigastric perforator (DIEP) flap has gained notoriety because of its proposed benefit in decreasing donor-site morbidity but has been associated with longer operative times, higher perfusion-related complications, and increased cost relative to muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flaps. The authors performed the first cost-utility analysis examining the cost effectiveness of DIEP flaps relative to muscle-sparing free TRAM flaps in women who underwent mastectomy.METHODS: A comprehensive literature review was conducted using the MED- LINE, Embase, and Cochrane library databases to include studies directly comparing DIEP to muscle-sparing free TRAM flaps in matched patient cohorts. Eight studies were included, examining 740 DIEP flaps and 807 muscle-sparing free TRAM flaps. Costs were derived adopting both societal and third-party payer perspectives. Utilities were derived from a previous cost-utility analysis. Probabilities of clinically relevant complications were combined with cost and utility estimates to fit into a decision tree analysis.RESULTS: The overall complication rates were 24.7 percent and 21.8 percent for DIEP and muscle-sparing free TRAM flaps, respectively. The authors' baseline analysis using Medicare reimbursement revealed a cost decrease of $69.42 and a clinical benefit of 0.0035 quality-adjusted life-year when performing DIEP flap surgery relative to muscle-sparing free TRAM flap surgery, yielding an incremental cost-utility ratio of -$19,834.29. When using societal costs, the incremental cost-utility ratio increased to $87,800.CONCLUSION: DIEP flaps are cost effective relative to muscle-sparing free TRAM flaps when patients are carefully selected based on perforator anatomy and surgery is performed by experienced surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) economics procedures EMTREE MEDICAL INDEX TERMS breast reconstruction comparative study cost benefit analysis female human mastectomy perforator flap surgical flaps LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25811560 (http://www.ncbi.nlm.nih.gov/pubmed/25811560) PUI L604638367 DOI 10.1097/PRS.0000000000001125 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001125 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 138 TITLE A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction AUTHOR NAMES Offodile A.C. Chatterjee A. Vallejo S. Fisher C.S. Tchou J.C. Guo L. AUTHOR ADDRESSES (Offodile A.C.; Chatterjee A.; Vallejo S.; Fisher C.S.; Tchou J.C.; Guo L.) Burlington, Mass.; and Philadelphia, Pa. From the Department of Plastic Surgery, Lahey Hospital and Medical Center; and the Divisions of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania SOURCE Plastic and reconstructive surgery (2015) 135:4 (662e-669e). Date of Publication: 1 Apr 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Computed tomographic angiography is a diagnostic tool increasingly used for preoperative vascular mapping in abdomen-based perforator flap breast reconstruction. This study compared the use of computed tomographic angiography and the conventional practice of Doppler ultrasonography only in postmastectomy reconstruction using a cost-utility model.METHODS: Following a comprehensive literature review, a decision analytic model was created using the three most clinically relevant health outcomes in free autologous breast reconstruction with computed tomographic angiography versus Doppler ultrasonography only. Cost and utility estimates for each health outcome were used to derive the quality-adjusted life-years and incremental cost-utility ratio. One-way sensitivity analysis was performed to scrutinize the robustness of the authors' results.RESULTS: Six studies and 782 patients were identified. Cost-utility analysis revealed a baseline cost savings of $3179, a gain in quality-adjusted life-years of 0.25. This yielded an incremental cost-utility ratio of -$12,716, implying a dominant choice favoring preoperative computed tomographic angiography. Sensitivity analysis revealed that computed tomographic angiography was costlier when the operative time difference between the two techniques was less than 21.3 minutes. However, the clinical advantage of computed tomographic angiography over Doppler ultrasonography only showed that computed tomographic angiography would still remain the cost-effective option even if it offered no additional operating time advantage.CONCLUSIONS: The authors' results show that computed tomographic angiography is a cost-effective technology for identifying lower abdominal perforators for autologous breast reconstruction. Although the perfect study would be a randomized controlled trial of the two approaches with true cost accrual, the authors' results represent the best available evidence. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost benefit analysis economics procedures EMTREE MEDICAL INDEX TERMS abdomen angiography breast reconstruction comparative study computer assisted tomography decision support system Doppler flowmetry evaluation study human perforator flap preoperative care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25517410 (http://www.ncbi.nlm.nih.gov/pubmed/25517410) PUI L604638339 DOI 10.1097/PRS.0000000000001133 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001133 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 139 TITLE The need for decision and communication AIDS: A survey of breast cancer survivors AUTHOR NAMES Belkora J.K. Miller M.F. Dougherty K. Gayer C. Golant M. Buzaglo J.S. AUTHOR ADDRESSES (Belkora J.K.) Institute for Health Policy Studies, University of California, San Francisco, United States. (Miller M.F.) Public Health Research Scientist, Fairfax, United States. (Dougherty K.) Research Partnership, Horsham, United States. (Gayer C.; Golant M.; Buzaglo J.S., joanne@cancersupportcommunity.org) Research and Training Institute, Cancer Support Community, Philadelphia, United States. CORRESPONDENCE ADDRESS J.S. Buzaglo, Research and Training Institute, Cancer Support Community, Philadelphia, United States. Email: joanne@cancersupportcommunity.org SOURCE Journal of Community and Supportive Oncology (2015) 13:3 (104-112). Date of Publication: 1 Mar 2015 ISSN 2330-7749 BOOK PUBLISHER Frontline Medical Communications, mholeton@frontlinemedcom.com ABSTRACT Background Qualitative studies have identified barriers to communication and informed decision making among breast cancer survivors making treatment decisions. The prevalence of these barriers is unknown. Objective To quantify the need for decision support among breast cancer survivors. Methods We surveyed 2,521 breast cancer survivors participating in an online registry hosted by the Cancer Support Community to find out what proportion of breast cancer patients: made decisions during their first visit with a specialist; received satisfactory information before that visit; asked questions and received responses; and endorsed expanded use of decision support. Results We received 1,017 (41%) responses and analyzed 917 surveys from women who lived in the United States. Most of the respondents recalled making treatment decisions during their first visit (52%). A minority (14%) received information before the first specialist visit. At least 25% of respondents rated their satisfaction below 7 on a scale of 10 for decision-making, information, and questions asked and answered. Respondents endorsed the need for assistance with obtaining information, listing questions, taking notes, and making audio-recordings of visits. Limitations The respondent sample skewed younger and had higher-stage cancer compared with all breast cancer survivors. Reponses were subject to recall bias. Conclusions Cancer survivors expressed gaps in their care with respect to reviewing information, asking questions, obtaining answers, and making decisions. Implementing decision and communication aids immediately upon diagnosis, when treatment decisions are being made, would address these gaps. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management) cancer survivor communication aid decision support system EMTREE MEDICAL INDEX TERMS adult aged article audio recording cancer diagnosis cancer therapy e-mail female health care health care policy human major clinical study male medical information medical oncologist medical specialist middle aged patient decision making patient guidance patient satisfaction radiation oncologist surgeon EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151048977 PUI L607347474 DOI 10.12788/jcso.0116 FULL TEXT LINK http://dx.doi.org/10.12788/jcso.0116 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 140 TITLE Re: Survival outcomes after contralateral prophylactic mastectomy: a decision analysis AUTHOR NAMES Narod S.A. AUTHOR ADDRESSES (Narod S.A.) SOURCE Journal of the National Cancer Institute (2015) 107:3. Date of Publication: 1 Mar 2015 ISSN 1460-2105 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system mastectomy mortality procedures EMTREE MEDICAL INDEX TERMS breast tumor (surgery) female human secondary prevention LANGUAGE OF ARTICLE English MEDLINE PMID 25713151 (http://www.ncbi.nlm.nih.gov/pubmed/25713151) PUI L603591503 DOI 10.1093/jnci/dju507 FULL TEXT LINK http://dx.doi.org/10.1093/jnci/dju507 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 141 TITLE A MDP model for breast and ovarian cancer intervention strategies for BRCA1/2 mutation carriers AUTHOR NAMES Abdollahian M. Das T.K. AUTHOR ADDRESSES (Abdollahian M.; Das T.K.) SOURCE IEEE journal of biomedical and health informatics (2015) 19:2 (720-727). Date of Publication: 1 Mar 2015 ISSN 2168-2208 (electronic) ABSTRACT PURPOSE: Women with BRCA1/2 mutations have higher risk for breast and ovarian cancers. Available intervention actions include prophylactic surgeries and breast screening, which vary significantly in cost, cancer prevention, and in resulting death from other causes. We present a model designed to yield optimal intervention strategies for mutation carriers between the ages of 30 and 65 and any prior intervention history.METHODS: A Markov decision process (MDP) model is developed that considers yearly state transitions for the mutation carriers and state dependent intervention actions. State is defined as a vector comprising mutation type, health states, prior intervention actions, and age. A discounted value iteration algorithm is used to obtain optimal strategies from the MDP model using both cost and quality-adjusted life years (QALYs) as rewards.RESULTS: The results from MDP model show that for 30-year-old women with BRCA1 mutation and no prior intervention history, the cost-optimal strategy is a combination of prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) at age 30 with no screening afterwards. Whereas, the QALYs-optimal strategy suggests PO at age 30 and PM at age 50 with screening afterwards. For BRCA2 mutation carriers at age 30, the cost-optimal strategy is PO at age 30, PM at age 40, and yearly screening only after age 56. Corresponding QALYs-optimal strategy is PM at age 40 with screening. Strategies for all other ages (31 to 65) are obtained and presented. It is also demonstrated that the cost-optimal strategies offer near maximum survival rate and near minimum cancer incidence rates by age 70, when compared to other ad hoc strategies. EMTREE DRUG INDEX TERMS BRCA1 protein BRCA1 protein, human BRCA2 protein BRCA2 protein, human EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (diagnosis, surgery) decision support system genetics ovary tumor (diagnosis, surgery) EMTREE MEDICAL INDEX TERMS adult aged early diagnosis female human mastectomy middle aged mutation ovariectomy probability prophylactic surgical procedure statistical model LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24771600 (http://www.ncbi.nlm.nih.gov/pubmed/24771600) PUI L607656814 DOI 10.1109/JBHI.2014.2319246 FULL TEXT LINK http://dx.doi.org/10.1109/JBHI.2014.2319246 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 142 TITLE Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) Prognostic Index AUTHOR NAMES Silverstein M.J. Lagios M.D. AUTHOR ADDRESSES (Silverstein M.J., melsilver9@gmail.com) Breast Service, Hoag Memorial Hospital Presbyterian, Newport Beach, United States. (Silverstein M.J., melsilver9@gmail.com) Keck School of Medicine, University of Southern California, Los Angeles, United States. (Lagios M.D.) Breast Cancer Consultation Service, Tiburon, United States. CORRESPONDENCE ADDRESS M.J. Silverstein, Gross Family Foundation Endowed Department of Oncoplastic Surgery, Hoag Breast Program, Hoag Memorial Hospital Presbyterian, Newport Beach, United States. SOURCE Breast Journal (2015) 21:2 (127-132). Date of Publication: 1 Mar 2015 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT The University of Southern California/Van Nuys Prognostic Index (USC/VNPI) is an algorithm that quantifies five measurable prognostic factors known to be important in predicting local recurrence in conservatively treated patients with ductal carcinoma in situ (DCIS) (tumor size, margin width, nuclear grade, age, and comedonecrosis). With five times as many patients since originally developed, sufficient numbers now exist for analysis by individual scores rather than groups of scores. To achieve a local recurrence rate of less than 20% at 12 years, these data support excision alone for all patients scoring 4, 5, or 6 and patients who score 7 but have margin widths ≥3 mm. Excision plus RT achieves the less than 20% local recurrence threshold at 12 years for patients who score 7 and have margins <3 mm, patients who score 8 and have margins ≥3 mm, and for patients who score 9 and have margins ≥5 mm. Mastectomy is required for patients who score 8 and have margins <3 mm, who score 9 and have margins <5 mm and for all patients who score 10, 11, or 12 to keep the local recurrence rate less than 20% at 12 years. DCIS is a highly favorable disease. There is no difference in mortality rate regardless of which treatment is chosen. The USC/VNPI is a numeric tool that can be used to aid the treatment decision-making process. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical assessment tool intraductal carcinoma (radiotherapy, surgery) university of Southern California van nuys prognostic index EMTREE MEDICAL INDEX TERMS adult article breast cancer cancer hormone therapy cancer mortality cancer patient cancer radiotherapy cancer recurrence cancer surgery cancer survival conservative treatment decision making female follow up human local recurrence free survival major clinical study mastectomy multimodality cancer therapy prospective study recurrence risk tumor volume EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015761443 MEDLINE PMID 25600630 (http://www.ncbi.nlm.nih.gov/pubmed/25600630) PUI L602424476 DOI 10.1111/tbj.12368 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12368 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 143 TITLE The use of mesh versus primary fascial closure of the abdominal donor site when using a transverse rectus abdominis myocutaneous flap for breast reconstruction: a cost-utility analysis AUTHOR NAMES Chatterjee A. Ramkumar D.B. Dawli T.B. Nigriny J.F. Stotland M.A. Ridgway E.B. AUTHOR ADDRESSES (Chatterjee A.; Ramkumar D.B.; Dawli T.B.; Nigriny J.F.; Stotland M.A.; Ridgway E.B.) Lebanon, N.H. From the Dartmouth-Hitchcock Medical Center SOURCE Plastic and reconstructive surgery (2015) 135:3 (682-689). Date of Publication: 1 Mar 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: During breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap, the use of mesh for abdominal donor-site closure provides for a technology that potentially offers clinical benefit yet incurs an added cost. The authors' goal was to determine whether it is cost effective to use mesh during abdominal donor-site closure when performing a TRAM flap for breast reconstruction.METHODS: A literature review was conducted to identify and collect published hernia and bulge rates at abdominal TRAM flap donor sites closed either primarily or with mesh. A decision tree analysis was performed. Outcome probabilities, costs of complications, and expert utility estimates were populated into the decision tree model to evaluate the cost-utility of using mesh in TRAM abdominal donor-site closure. One-way sensitivity analyses were performed to verify the robustness of the results.RESULTS: The authors' literature review resulted in 10 articles describing 1195 patients who had TRAM abdominal donor-site closure primarily and 696 patients who had donor-site closure performed with mesh. Pooled hernia/bulge complication rates for these two groups were 7.87 percent and 4.45 percent, respectively. The use of mesh was more clinically effective based on total quality-adjusted life-years gained of 30.53 compared with 30.41 when performing primary fascial closure alone. The incremental additional cost incurred by the mesh arm when running the decision tree model was $693.14. This difference in cost, divided by the difference in clinical efficacy (0.12), results in an incremental cost-utility ratio value of $5776.17 per quality-adjusted life-year gained when using mesh, making it cost effective (when using a willingness-to-pay threshold of $50,000). One-way sensitivity analysis revealed the following: (1) using mesh was a cost effective option, provided that the price of mesh was less than or equal to $5970; (2) mesh was cost effective when its use led to a hernia/bulge rate less than or equal to 7.25 percent; and (3) primary facial closure was cost effective when its use led to a hernia/bulge rate less than or equal to 4.75 percent.CONCLUSION: The use of mesh when repairing the abdominal donor site during a pedicled or free TRAM flap breast reconstruction is cost effective compared with primary fascial closure alone. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) economics myocutaneous flap procedures surgery transplantation EMTREE MEDICAL INDEX TERMS breast reconstruction cost benefit analysis fascia female human rectus abdominis muscle wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25719690 (http://www.ncbi.nlm.nih.gov/pubmed/25719690) PUI L604826315 DOI 10.1097/PRS.0000000000000957 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000957 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 144 TITLE Response AUTHOR NAMES Portschy P.R. Kuntz K.M. Tuttle T.M. AUTHOR ADDRESSES (Portschy P.R.; Kuntz K.M.; Tuttle T.M.) SOURCE Journal of the National Cancer Institute (2015) 107:3. Date of Publication: 1 Mar 2015 ISSN 1460-2105 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system mastectomy mortality procedures EMTREE MEDICAL INDEX TERMS breast tumor (surgery) female human secondary prevention LANGUAGE OF ARTICLE English MEDLINE PMID 25713152 (http://www.ncbi.nlm.nih.gov/pubmed/25713152) PUI L603591514 DOI 10.1093/jnci/dju508 FULL TEXT LINK http://dx.doi.org/10.1093/jnci/dju508 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 145 TITLE Better contralateral breast cancer risk estimation and alternative options to contralateral prophylactic mastectomy AUTHOR NAMES Davies K.R. Cantor S.B. Brewster A.M. AUTHOR ADDRESSES (Davies K.R.; Cantor S.B.) Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, United States. (Brewster A.M., abrewster@mdanderson.org) Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, United States. CORRESPONDENCE ADDRESS A.M. Brewster, Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit Number 1360, Houston, United States. SOURCE International Journal of Women's Health (2015) 7 (181-187). Date of Publication: 4 Feb 2015 ISSN 1179-1411 (electronic) BOOK PUBLISHER Dove Medical Press Ltd, PO Box 300-008, Albany, 44 Corinthian Drive, Albany,Auckland, New Zealand. angela@dovepress.com ABSTRACT The incidence of contralateral prophylactic mastectomy (CPM) has increased among women with breast cancer, despite uncertain survival benefit and a declining incidence of contralateral breast cancer (CBC). Patient-related reasons for undergoing CPM include an overestimation of the risk of CBC, increased cancer worry, and a desire to improve survival. We summarize the existing literature on CBC risk and outcomes and the clinical benefit of CPM among women with unilateral breast cancer who have a low-to-moderate risk of developing a secondary cancer in the contralateral breast. Published studies were retrieved from the MEDLINE database with the keywords “contralateral breast cancer” and “contralateral prophylactic mastectomy”. These include observational studies, clinical trials, survival analyses, and decision models examining the risk of CBC, the clinical and psychosocial effects of CPM, and other treatment strategies to reduce CBC risk. Studies that have evaluated CBC risk estimate it to be approximately 0.5% annually on average. Patient-related factors associated with an increased risk of CBC include carriers of BRCA1/2 mutations, young age at breast cancer, and strong family history of breast cancer in the absence of a BRCA1/2 mutation. Although CPM reduces the risk of CBC by approximately 94%, it may not provide a significant gain in overall survival and there is conflicting evidence that it improves disease-free survival among women with breast cancer regardless of estrogen receptor (ER) status. Therefore, alternative strategies such as the use of tamoxifen or aromatase inhibitors, which reduce the risk of CBC by approximately 50%, should be encouraged for eligible women with ER-positive breast cancers. Future research is needed to evaluate the impact of decision and educational tools that can be used for personalized counseling of patients regarding their CBC risk, the uncertain role of CPM, and alternative CBC risk reduction strategies. EMTREE DRUG INDEX TERMS aromatase inhibitor (drug therapy) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) estrogen receptor (endogenous compound) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, prevention, surgery) cancer risk contralateral breast cancer (drug therapy, drug therapy, prevention, surgery) contralateral prophylactic mastectomy mastectomy EMTREE MEDICAL INDEX TERMS article cancer prognosis cancer survival clinical decision making clinical effectiveness disease free survival family history gene mutation heterozygote human low risk patient outcome assessment overall survival risk assessment risk reduction social psychology survival prediction survival rate survival time systematic review tumor suppressor gene CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015729648 PUI L602074936 DOI 10.2147/IJWH.S52380 FULL TEXT LINK http://dx.doi.org/10.2147/IJWH.S52380 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 146 TITLE A classification system for fat necrosis in autologous breast reconstruction AUTHOR NAMES Könneker S. Vogt P.M. Jokuszies A. AUTHOR ADDRESSES (Könneker S.; Vogt P.M.; Jokuszies A.) Department of Plastic Hand and Reconstructive Surgery Hannover Medical School Hannover, Germany SOURCE Annals of plastic surgery (2015) 74:2 (269). Date of Publication: 1 Feb 2015 ISSN 1536-3708 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction classification decision support system EMTREE MEDICAL INDEX TERMS fat necrosis female human postoperative complication LANGUAGE OF ARTICLE English MEDLINE PMID 25590246 (http://www.ncbi.nlm.nih.gov/pubmed/25590246) PUI L604459935 DOI 10.1097/01.sap.0000460803.22412.44 FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000460803.22412.44 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 147 TITLE Variation in contralateral prophylactic mastectomy rates according to racial groups in young women with breast cancer, 1998 to 2011: A report from the National Cancer Data Base AUTHOR NAMES Grimmer L. Liederbach E. Velasco J. Pesce C. Wang C.-H. Yao K. AUTHOR ADDRESSES (Grimmer L.) Department of Surgery, Rush University Medical College, Chicago, United States. (Liederbach E.; Velasco J.; Pesce C.; Yao K., kyao@northshore.org) Department of Surgery, NorthShore University Health System, Evanston, United States. (Wang C.-H.) Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, United States. CORRESPONDENCE ADDRESS K. Yao, Department of Surgery, NorthShore University Health System, Evanston, United States. SOURCE Journal of the American College of Surgeons (2015) 221:1 (187-196). Date of Publication: 1 Jul 2015 ISSN 1879-1190 (electronic) 1072-7515 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background The rate of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer has increased over the past decade, particularly for young women. This study investigates the impact of race and socioeconomic status (SES) on use of CPM. Study Design Using the National Cancer Data Base (NCDB), we selected 1,781,409 stage 0 to II unilateral breast cancer patients between 1998 and 2011. Trends in use of CPM by race and SES were analyzed using chi-square tests and logistic regression models. Results For women of all ages, rates of CPM increased, from 1.9% in 1998 to 10.2% in 2011 (p < 0.001), with higher rates in women ≤45 years old, rising from 3.7% in 1998 to 26.2% in 2011 (p < 0.001). Among young women, white women had the greatest increase in CPM from 4.3% in 1998 to 30.2% in 2011 (p < 0.001). In 2011, CPM rates were 30.2% for white, 18.5% for Hispanic, 16.5% for black, and 15.2% for Asian patients (p < 0.001). The gap in CPM use between white and minority patients persisted in every SES classification, geographic region, and facility type. On multivariate analysis, minority women were 50% less likely to undergo CPM than white women were. Conclusions Young, white, breast cancer patients are twice as likely to undergo CPM compared with women in other racial groups, even after accounting for pathologic, patient, and facility factors. Variations in shared decision-making processes between women of different backgrounds may contribute to these trends, supporting the need for future studies investigating decision-making processes and decisional aids. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ancestry group breast cancer (diagnosis, disease management, prevention, surgery) contralateral prophylactic mastectomy mastectomy social status EMTREE MEDICAL INDEX TERMS adult cancer prevention cancer staging demography female health insurance human major clinical study medical decision making predictor variable priority journal prophylactic surgical procedure review surgical technique tumor volume EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015088092 MEDLINE PMID 26047763 (http://www.ncbi.nlm.nih.gov/pubmed/26047763) PUI L604655086 DOI 10.1016/j.jamcollsurg.2015.03.033 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2015.03.033 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 148 TITLE Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer AUTHOR NAMES Savelberg W. Moser A. Smidt M. Boersma L. Haekens C. Van Der Weijden T. AUTHOR ADDRESSES (Savelberg W., w.savelberg@mumc.nl; Smidt M.; Haekens C.) Oncology Center, Maastricht University Medical Center, Maastricht, Netherlands. (Moser A.) Zuyd University of Applied Sciences, Heerlen, Netherlands. (Boersma L.) Department of Radiotherapy, Maastricht University Medical Center, Maastricht, Netherlands. (Van Der Weijden T.) Department of Family Medicine, Maastricht University, Maastricht, Netherlands. (Van Der Weijden T.) School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands. CORRESPONDENCE ADDRESS W. Savelberg, Oncology Center, Maastricht University Medical Center, Maastricht, Netherlands. SOURCE BMJ Open (2015) 5:3 Article Number: e007698. Date of Publication: 2015 ISSN 2044-6055 (electronic) BOOK PUBLISHER BMJ Publishing Group, subscriptions@bmjgroup.com ABSTRACT Background: The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients' informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. Methods/design: This paper concerns a preimplementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid. Ethics and dissemination: This protocol was approved by the Maastricht University Medical Centre (MUMC) ethics committee. The findings will be disseminated through peer-reviewed journal articles and presentations at national conferences. Findings will be used to finalise a multi-faceted implementation strategy to test the implementation of SDM and a patient decision aid in terms of cost-effectiveness, in a multicentre cluster randomised controlled trial (RCT). Study registration number: NTR4879. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) clinical protocol patient decision making EMTREE MEDICAL INDEX TERMS article cancer staging cancer surgery clinical article controlled study cost effectiveness analysis female health care planning human intervention study interview outcome assessment qualitative research quantitative analysis randomized controlled trial treatment outcome EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Surgery (9) CLINICAL TRIAL NUMBERS LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015903948 MEDLINE PMID 25829374 (http://www.ncbi.nlm.nih.gov/pubmed/25829374) PUI L603571736 DOI 10.1136/bmjopen-2015-007698 FULL TEXT LINK http://dx.doi.org/10.1136/bmjopen-2015-007698 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 149 TITLE Decision aids for people considering taking part in clinical trials AUTHOR NAMES Gillies K. Cotton S.C. Brehaut J.C. Politi M.C. Skea Z. AUTHOR ADDRESSES (Gillies K.; Cotton S.C.; Brehaut J.C.; Politi M.C.; Skea Z.) Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25 2ZB SOURCE The Cochrane database of systematic reviews (2015) 11 (CD009736). Date of Publication: 2015 ISSN 1469-493X (electronic) ABSTRACT BACKGROUND: Several interventions have been developed to promote informed consent for participants in clinical trials. However, many of these interventions focus on the content and structure of information (e.g. enhanced information or changes to the presentation format) rather than the process of decision making. Patient decision aids support a decision making process about medical options. Decision aids support the decision process by providing information about available options and their associated outcomes, alongside information that enables patients to consider what value they place on particular outcomes, and provide structured guidance on steps of decision making. They have been shown to be effective for treatment and screening decisions but evidence on their effectiveness in the context of informed consent for clinical trials has not been synthesised.OBJECTIVES: To assess the effectiveness of decision aids for clinical trial informed consent compared to no intervention, standard information (i.e. usual practice) or an alternative intervention on the decision making process.SEARCH METHODS: We searched the following databases and to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; MEDLINE (OvidSP) (from 1950); EMBASE (OvidSP) (from 1980); PsycINFO (OvidSP) (from 1806); ASSIA (ProQuest) (from 1987); WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/); ClinicalTrials.gov; ISRCTN Register (http://www.controlled-trials.com/isrctn/). We also searched reference lists of included studies and relevant reviews. We contacted study authors and other experts. There were no language restrictions.SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials comparing decision aids in the informed consent process for clinical trials alone, or in conjunction with standard information (such as written or verbal) or alongside alternative interventions (e.g. paper-based versus web-based decision aids). Included trials involved potential trial participants, or their guardians, being asked to consider participating in a real or hypothetical clinical trial.DATA COLLECTION AND ANALYSIS: At least two authors independently assessed studies for inclusion, extracted reported data and assessed risk of bias. Findings were pooled where appropriate. We used GRADE to assess the quality of the evidence for each outcome.MAIN RESULTS: We identified one study (290 randomised participants) that investigated the effectiveness of decision aids compared to standard information in the informed consent process for clinical trials. This study reported two separate decision aid randomised controlled trials (RCTs). The decision aid trials were nested within two different parent trials focusing on breast cancer in postmenopausal women. One trial focused on informed consent for treatment in women who had previously had surgery for ductal carcinoma in situ (DCIS), the other on informed consent for prevention in women at high risk for breast cancer. Two different decision aids were used in these RCTs, and were compared with standard information.The pooled findings highlight the uncertainty surrounding most reported outcomes, including knowledge, decisional conflict, anxiety, trial participation and attrition. There was very low quality evidence that decision aids lower levels of decisional regret to a small degree (MD -5.53, 95% CI -10.29 to -0.76). No data were identified on several prespecified primary outcomes, including accurate risk perception, values-based decision, or whether potential participants recognised that a decision needed to be made, were able to identify features of options that matter most to individuals, or were involved in the decision.AUTHORS' CONCLUSIONS: There was insufficient evidence to determine whether decision aids to support the informed consent process for clinical trials are more effective than standard information. Additional well designed, adequately powered clinical trials in more diverse clinical and social populations are needed to strengthen the results of this review. More generally, future research on which outcomes are most relevant for assessment in this context would be helpful. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical trial (topic) decision making decision support system informed consent patient participation EMTREE MEDICAL INDEX TERMS human randomized controlled trial (topic) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26613337 (http://www.ncbi.nlm.nih.gov/pubmed/26613337) PUI L609618279 DOI 10.1002/14651858.CD009736.pub2 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD009736.pub2 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 150 TITLE ReconstrucciÓn inmediata en cÁncer de mama. ¿las mujeres estÁn satisfechas con su decisiÓn? AUTHOR NAMES López M.L.F. De Molina Fernández I. Rodríguez A.S. Montes Muñoz M.J. AUTHOR ADDRESSES (López M.L.F., mdelaflor.hj23.ics@gencat.cat) Servicio de Ginecología and Obstetricia, H.U. De Tarragona Joan XXII, Departamento de Medicina and Cirugía Universidad Rovira i Virgili. Instituto Investigaciones Sanitarias Pere Virgili, Tarragona, Spain. (De Molina Fernández I.; Montes Muñoz M.J.) Departamento de Enfermería, Universidad Rovira i Virgili, Tarragona, Spain. (Rodríguez A.S.) Unidad de Psicooncologia, Instituto de Oncología de la Catalunya Sud. Servicio de Oncología H.U. Sant Joan de Reus, Departamento de Medicina and Cirugía Universidad Rovira i Virgili Instituto Investigaciones Sanitarias Pere Virgili, Reus, Spain. CORRESPONDENCE ADDRESS M.L.F. López, Avda. Roma 19 10º 4ª, Tarragona, Spain. Email: mdelaflor.hj23.ics@gencat.cat SOURCE Psicooncologia (2015) 12:2-3 (393-403). Date of Publication: 2015 ISSN 1988-8287 (electronic) 1696-7240 BOOK PUBLISHER Spanish Association of Anglo-American Studies ABSTRACT Objective: To know the experiences, expectations and perceived satisfaction in a group of breast cancer women who had undergone immediate breast reconstruction after mastectomy. Material and Methods: 20 women took part in a qualitative study. 4 women were assessed through an in-depth interview and the other 16 women were divided into two focus groups (8 each). The recorded interview and focus group discussions were transcribed and analyzed using “framework analysis”. Results: Five areas were explored: 1) Impact of cancer diagnosis, 2) Information received about the surgery, 3) Post-surgery experiences, 4) Fulfilment of expectations and 5) Satisfaction with the decision. Cancer diagnosis was overwhelming for most of the women. For women, information received was considered good and sufficient, but the study shows that after the post-surgical period, more complaints related to pain and other complications appear. The expectations about immediate breast reconstruction were linked with the final aesthetic results. Some women would choose to do the same procedure again despite the complications but some other women would not choose the same option because of the complications and they regret their decision. Conclusion: There is no clear and unanimous position among women about whether they would go through immediate breast reconstruction again and whether the surgery has fulfilled their expectations. The patients need complete, unbiased and appropriate information in order to be able to make an informed and shared decision. It is for that reason that we think it is necessary to devise patient decision aids which could facilitate the information delivering process to patients EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction experience mastectomy patient satisfaction personal experience EMTREE MEDICAL INDEX TERMS article cancer diagnosis clinical article female human interview patient decision making qualitative research EMBASE CLASSIFICATIONS Cancer (16) Psychiatry (32) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 20160055488 PUI L607814150 DOI 10.5209/rev_PSIC.2015.v12.n2-3.51017 FULL TEXT LINK http://dx.doi.org/10.5209/rev_PSIC.2015.v12.n2-3.51017 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 151 TITLE How can we best respect patient autonomy in breast cancer treatment decisions? AUTHOR NAMES Martinez K.A. Kurian A.W. Hawley S.T. Jagsi R. AUTHOR ADDRESSES (Martinez K.A., makathry@med.umich.edu; Hawley S.T.) VA Center for Clinical Management Research, Building 16, 2800 Plymouth Road, Ann Arbor, United States. (Kurian A.W.) Stanford University School of Medicine, 291 Campus Dr, Stanford, United States. (Hawley S.T.) Division of General Medicine, University of Michigan, Building 16, 2800 Plymouth Road, Ann Arbor, United States. (Jagsi R.) Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, United States. CORRESPONDENCE ADDRESS K.A. Martinez, VA Center for Clinical Management Research, Building 16, 2800 Plymouth Road, Ann Arbor, United States. SOURCE Breast Cancer Management (2015) 4:1 (53-64). Date of Publication: 1 Jan 2015 ISSN 1758-1931 (electronic) 1758-1923 BOOK PUBLISHER Future Medicine Ltd., info@futuremedicine.com ABSTRACT Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients' risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) medical decision making patient autonomy patient decision making EMTREE MEDICAL INDEX TERMS cancer chemotherapy cancer hormone therapy cancer radiotherapy cancer surgery cancer therapy decision support system doctor patient relation evidence based medicine genetic screening health care delivery human medical care medical ethics patient care patient participation patient preference patient satisfaction priority journal review uncertainty EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015663047 PUI L601246077 DOI 10.2217/bmt.14.47 FULL TEXT LINK http://dx.doi.org/10.2217/bmt.14.47 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 152 TITLE Radiation therapy in the locoregional treatment of triple-negative breast cancer AUTHOR NAMES Moran M.S. AUTHOR ADDRESSES (Moran M.S., Meena.Moran@yale.edu) Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, United States. CORRESPONDENCE ADDRESS M.S. Moran, Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, United States. SOURCE The Lancet Oncology (2015) 16:3 (e113-e122). Date of Publication: 1 Mar 2015 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com ABSTRACT This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to. EMTREE DRUG INDEX TERMS cytokeratin 17 (endogenous compound) cytokeratin 5 (endogenous compound) cytokeratin 6 (endogenous compound) epidermal growth factor receptor (endogenous compound) stem cell factor (endogenous compound) trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer radiotherapy local recurrence free survival triple negative breast cancer (drug therapy, drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS cancer classification cancer recurrence cancer surgery cancer survival fluorescence in situ hybridization gene expression profiling gene mutation genetic association genetic screening homologous recombination human immunohistochemistry mastectomy molecular typing oncogene overall survival priority journal radiosensitivity review TP53 gene tumor suppressor gene tumor volume whole body radiation CAS REGISTRY NUMBERS epidermal growth factor receptor (79079-06-4) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Human Genetics (22) Drug Literature Index (37) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT00103181) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015835437 MEDLINE PMID 25752562 (http://www.ncbi.nlm.nih.gov/pubmed/25752562) PUI L603059892 DOI 10.1016/S1470-2045(14)71104-0 FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(14)71104-0 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 153 TITLE Re: Survival outcomes after contralateral prophylactic mastectomy: A decision analysis AUTHOR NAMES Narod S.A. AUTHOR ADDRESSES (Narod S.A., steven.narod@wchospital.ca) Familial Breast Cancer Research Unit, Women's College Research Institute, Canada. CORRESPONDENCE ADDRESS S.A. Narod, 790 Bay St, Toronto, Canada. SOURCE Journal of the National Cancer Institute (2015) 107:4. Date of Publication: 1 Apr 2015 ISSN 1460-2105 (electronic) 0027-8874 BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (prevention, surgery) cancer survival mastectomy EMTREE MEDICAL INDEX TERMS cancer epidemiology comorbidity disease free survival educational status family history human letter priority journal EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015115805 MEDLINE PMID 25870387 (http://www.ncbi.nlm.nih.gov/pubmed/25870387) PUI L604801407 DOI 10.1093/jnci/djv092 FULL TEXT LINK http://dx.doi.org/10.1093/jnci/djv092 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 154 TITLE Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? AUTHOR NAMES Tokés T. Torgyík L. Szentmártoni G. Somlai K. Tóth A. Kulka J. Dank M. AUTHOR ADDRESSES (Tokés T., tokes.timea@med.semmelweis-univ.hu; Torgyík L.; Szentmártoni G.; Somlai K.; Tóth A.; Dank M.) Semmelweis University, Department of Internal Medicine, Oncology Division, Budapest, Hungary. (Somlai K.) St. Margaret Hospital, Surgical Division, Budapest, Hungary. (Kulka J.) Semmelweis University, Department of Pathology, Budapest, Hungary. CORRESPONDENCE ADDRESS T. Tokés, Semmelweis University, Department of Internal Medicine, Oncology Division, Tömoutca 25-29,4th floor, Budapest, Hungary. SOURCE Patient Education and Counseling (2015) 98:6 (695-703). Date of Publication: 1 Jun 2015 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated. Methods: We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC. Results: A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery. Conclusion: Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival. Practice implications: Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) locally advanced breast cancer patient decision making patient participation primary systemic therapy systemic therapy EMTREE MEDICAL INDEX TERMS advanced cancer breast cancer breast surgery cancer patient cancer surgery cancer survival decision support system factor analysis human integrated health care system interpersonal communication medical decision making medical information medical oncologist medical practice patient education patient preference personalized medicine practice guideline priority journal review survival time EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015806826 MEDLINE PMID 25749023 (http://www.ncbi.nlm.nih.gov/pubmed/25749023) PUI L602811417 DOI 10.1016/j.pec.2015.02.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2015.02.012 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 155 TITLE Expected survival with and without second-line palliative chemotherapy: Who wants to know? ORIGINAL (NON-ENGLISH) TITLE Overlevingsinformatie bij tweedelijns-chemotherapie: Wie wil het weten? AUTHOR NAMES Oostendorp L.J.M. Ottevanger P.B. Van De Wouw A.J. Schoenaker I.J.H. De Graaf H. Van Der Graaf W.T.A. Stalmeier P.F.M. AUTHOR ADDRESSES (Oostendorp L.J.M., lindaoostendorp@hotmail.com; Stalmeier P.F.M.) Department for Health Evidence, Netherlands. (Ottevanger P.B.; Van Der Graaf W.T.A.) Medische Oncologie, VieCuri Medisch Centrum, Netherlands. (Van De Wouw A.J.) Interne Geneeskunde, Venlo, Netherlands. (Schoenaker I.J.H.) Interne Geneeskunde, Medisch Centrum Leeuwarden, Zwolle, Netherlands. (De Graaf H.) Oncologisch Centrum, Leeuwarden, Netherlands. SOURCE Nederlands Tijdschrift voor Geneeskunde (2015) 159:26. Date of Publication: 2015 ISSN 0028-2162 BOOK PUBLISHER Bohn Stafleu van Loghum, boekhandels@bsl.nl ABSTRACT Objective According to surveys, many patients with advanced cancer wish to receive survival information. This study investigated information preferences by offering patients a decision aid (DA) with information on expected survival for two treatment options: supportive care with or without secondline palliative chemotherapy. Predictors of accepting survival information were explored. Design Multicentre prospective study. Method Eligible patients were offered secondline chemotherapy for advanced breast or colorectal cancer. A nurse presented a DA on secondline treatment and asked patients whether they desired information on (i) adverse events, (ii) tumour response and (iii) survival. Data on 50 clinical and psychosocial patient characteristics were collected from inclusion forms and patient questionnaires. Results Seventyseven patients received a DA; median age 62 years (range 3280), 61% female, 77% colorectal cancer. Fiftyseven patients (74%; 95% CI 6484) desired survival information. Four psychosocial characteristics (e.g. deliberative decision style) independently predicted information desire. However, the use of these characteristics to predict information desire hardly outperformed a simple prediction rule. Conclusion Many patients desired information on expected survival when deciding about second-line treatment. However, our exploratory analysis indicated that patients desiring this information could not be identified based on their clinical or psychosocial characteristics. These findings can help encourage candid discussions about expected survival. Health professionals should be careful not to make implicit assumptions of information desire based on patient characteristics, but to explicitly ask patients if survival information is desired, and act accordingly. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (clinical trial, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer chemotherapy cancer palliative therapy cancer survival EMTREE MEDICAL INDEX TERMS adult advanced cancer (drug therapy) aged article breast cancer (drug therapy) cancer patient colorectal cancer (drug therapy) female human major clinical study male multicenter study patient decision making prospective study social psychology EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Gastroenterology (48) LANGUAGE OF ARTICLE Dutch LANGUAGE OF SUMMARY English, Dutch EMBASE ACCESSION NUMBER 2015159307 PUI L605006371 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 156 TITLE Erratum: Re: Survival outcomes after contralateral prophylactic mastectomy: A decision analysis (Journal of the National Cancer Institute (2014) 107:3 (dju507) DOI: 10.1093/jnci/dju507) AUTHOR NAMES Narod S.A. AUTHOR ADDRESSES (Narod S.A.) CORRESPONDENCE ADDRESS S.A. Narod, SOURCE Journal of the National Cancer Institute (2015) 107:4. Date of Publication: 1 Apr 2015 ISSN 1460-2105 (electronic) 0027-8874 BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015115818 PUI L604801426 DOI 10.1093/jnci/djv096 FULL TEXT LINK http://dx.doi.org/10.1093/jnci/djv096 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 157 TITLE Primary breast cancer with synchronous metastatic disease-indications for local radiotherapy to the breast and chest wall AUTHOR NAMES Janssen S. Rades D. AUTHOR ADDRESSES (Janssen S., s.janssen@strahlentherapie.de) Private Practice of Radiation Oncology, Rundestr. 10, Hannover, Germany. (Janssen S., s.janssen@strahlentherapie.de; Rades D.) Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. CORRESPONDENCE ADDRESS S. Janssen, Private Practice of Radiation Oncology, Rundestr. 10, Hannover, Germany. SOURCE Anticancer Research (2015) 35:11 (5807-5812). Date of Publication: 1 Nov 2015 ISSN 0250-7005 BOOK PUBLISHER International Institute of Anticancer Research, 1st km Kapandritiou - Kalamou Rd., P.O. Box 22, Kapandriti, Attica, Greece. ABSTRACT Aim: To review literature on local therapy in patients with primary metastatic breast cancer with focus on local radiotherapy (RT). Patients and Methods: A Medline search using the key words metastatic breast cancer, primary resection/radiotherapy, local therapy, local radiotherapy was carried out. All original studies in the English language were included in the present review. Results: A total of 27 original studies including more than 33,000 patients with metastatic breast cancer were identified, including two large database analyses (n=25,757). All studies were retrospective in nature. Most studies showed a survival benefit with the addition of local therapy in a metastatic situation. The majority of studies focused on the role of surgery. Fourteen studies (52%) mentioned radiotherapy (RT) in 0.3% to 100% of patients. Six of these studies analyzed the effect of RT separately and five found an additional benefit of RT. Two studies showed best outcomes when RT and surgery were combined. Conclusion: Most retrospective studies showed a survival benefit for local therapy in patients with breast cancer with distant metastases. The role of RT remains unclear. Some reports showed improved outcome with the combination of surgery and RT. This approach should be considered in patients with good survival prognosis in whom local control is important. There are several prognostic factors to aid decision-making. Results of prospective randomized studies are pending. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer radiotherapy distant metastasis (radiotherapy) metastatic breast cancer (radiotherapy) synchronous metastatic disease (radiotherapy) thorax wall cancer (radiotherapy) EMTREE MEDICAL INDEX TERMS cancer prognosis cancer surgery cancer survival cancer therapy human induction chemotherapy local therapy medical decision making Medline metastasis resection outcome assessment priority journal prospective study randomized controlled trial (topic) retrospective study review systemic therapy treatment indication EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Cardiovascular Diseases and Cardiovascular Surgery (18) Internal Medicine (6) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01015625) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015490402 MEDLINE PMID 26504001 (http://www.ncbi.nlm.nih.gov/pubmed/26504001) PUI L606736319 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 158 TITLE Treatment for older women with breast cancer-challenges and opportunities-an experience from Toronto Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada AUTHOR NAMES Szumacher E.F. Harth T. Fitch M. Trudeau M. McGuffin M. Prospero L. Feldman-Stewart D. AUTHOR ADDRESSES (Szumacher E.F.; Harth T.; Fitch M.; Trudeau M.; McGuffin M.; Prospero L.) Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. (Feldman-Stewart D.) Oncology, Queens University, Kingston, Canada. CORRESPONDENCE ADDRESS E.F. Szumacher, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. SOURCE Asia-Pacific Journal of Clinical Oncology (2014) 10 SUPPL. 9 (67). Date of Publication: December 2014 CONFERENCE NAME 2014 World Cancer Congress CONFERENCE LOCATION Melbourne, VIC, Australia CONFERENCE DATE 2014-12-03 to 2014-12-06 ISSN 1743-7555 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: As the mean age of the global population increases, breast cancer in older women will be increasingly encountered in clinical practice Aim: To present the needs, decisional support and development of a patient decision-aid (PtDA) for women 70 years and older post lumpectomy with early stage breast cancer Methods: Focus groups, one-on-one patient interviews and a survey were conducted. Patients' decision aid was developed. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, and level of distress, treatment-related knowledge, and choice predisposition Results: Sixteen women participated in focus groups, age 76 (range: 70 to 84), and ninety-two, 60 years and older participated in the survey. The majority of women received adequate decisional support during their cancer journey. No significant differences in overall decisional support based on age at diagnosis, education level, ethnicity or the presence of co morbidities. Participants desired educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use Conclusions: Our studies showed that treatments for older women with breast cancer should be tailored according to their needs. Our group is working towards development of a multidisciplinary clinical program for frail women with breast cancer. The results of our studies will be presented at the congress. EMTREE DRUG INDEX TERMS methyldopa EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer Canada cancer center female human neoplasm EMTREE MEDICAL INDEX TERMS clinical practice confidence interval consultation diagnosis disease predisposition education ethnicity information processing interview morbidity partial mastectomy patient population potential difference risk satisfaction vascular guide wire LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71740618 DOI 10.1111/ajco.12332 FULL TEXT LINK http://dx.doi.org/10.1111/ajco.12332 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 159 TITLE Improved results after implementation of the Ghent algorithm for subcutaneous mastectomy in female-to-male transsexuals AUTHOR NAMES Bjerrome Ahlin H. Kölby L. Elander A. Selvaggi G. AUTHOR ADDRESSES (Bjerrome Ahlin H.; Kölby L.; Elander A.; Selvaggi G.) Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden SOURCE Journal of plastic surgery and hand surgery (2014) 48:6 (362-367). Date of Publication: 1 Dec 2014 ISSN 2000-6764 (electronic) ABSTRACT The subcutaneous mastectomy is an important step in the treatment of female-to-male transsexual patients. At the Sahlgrenska University Hospital, a two-step procedure was used for mastectomies through 2002-2011. With this procedure, all patients were operated on with a concentric circular incision in the first session of surgery, followed by a second session 7-12 months later. From July 2011, a new approach was adopted, which consists of treating patients according to the algorithm and methods described by Monstrey et al. The aim of this study is to evaluate these two different approaches and determine if similar results, possibly with fewer surgeries and overall lower complication rate, can be achieved by using multiple techniques and a decision-making algorithm as compared to the two-step approach where only a concentric circular technique was used. All female-to-male transsexuals who had mastectomy at Sahlgrenska between 2002-2012 were included in the study. These were divided in two groups: those who were treated according to the single-step, algorithm based, approach (16 patients, 32 mastectomies), and those who were treated with the two-step, concentric circular approach (14 patients, 28 mastectomies). Within the single-step, algorithm based, group the following techniques were used: 6% transareolar technique, 6% semicircular, 13% free nipple graft, 31% extended concentric circular, and 44% concentric circular. Data including type of surgical technique used, complications, and number of surgeries were collected and compared. Complications (e.g., haematoma, nipple necrosis, seroma, wound dehiscence, and infection) occurred in 50% of the patients following the first surgery in the two-step, concentric-circular approach group, for a total of 71.43% of patients with complications following either the first- or the second-step surgery; complications occurred only in 25% of the patients in the one-step, algorithm-based group. The mean number of surgeries per breast was 2.5 for the two-step concentric circular approach, and 1.25 for the single step, algorithm-based approach; particularly, when the concentric circular technique was chosen for the single step, algorithm-based approach, only two of the patients required revision surgery to improve the cosmetic outcome. This study shows that the number of complications and the total number of surgeries performed to satisfy patients were lower after Monstrey's algorithm for mastectomies was implemented as routine practice at the Sahlgrenska University Hospital. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system procedures subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult body mass female human male scar (surgery) sex reassignment transsexualism (surgery) treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24611803 (http://www.ncbi.nlm.nih.gov/pubmed/24611803) PUI L605157577 DOI 10.3109/2000656X.2014.893887 FULL TEXT LINK http://dx.doi.org/10.3109/2000656X.2014.893887 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 160 TITLE “not just following what doctors say”: Piloting of a decision aid for women considering participation in the sentinel node biopsy versus axillary clearance 2 (SNAC2) trial AUTHOR NAMES Fisher A. Juraskova I. Butow P. Bonner C. Anderson C. Scarlet J. Stockler M. Wetzig N. Ung O. Gill G. Campbell I. AUTHOR ADDRESSES (Fisher A.; Juraskova I.; Butow P.; Bonner C.; Anderson C.) School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia. (Scarlet J.; Campbell I.) Breast Cancer Centre, Waikato Hospital, Hamilton, New Zealand. (Stockler M.) NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. (Wetzig N.) Princess Alexandra Hospital, Brisbane, Australia. (Ung O.) Royal Brisbane and Women's Hospital, Brisbane, Australia. (Ung O.) Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia. (Gill G.) Royal Adelaide Hospital, Adelaide, Australia. CORRESPONDENCE ADDRESS A. Fisher, School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2014) 10 SUPPL. 8 (107). Date of Publication: December 2014 CONFERENCE NAME 41st Annual Scientific Meeting of the Clinical Oncological Society of Australia. Joining Forces - Accelerating Progress, COSA 2014 CONFERENCE LOCATION Melbourne, VIC, Australia CONFERENCE DATE 2014-12-02 to 2014-12-04 ISSN 1743-7555 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Aims: Suboptimal understanding of clinical trial-related information may not only compromise accrual, but also the informed consent process. Decision aids (DAs) enhance patient understanding and decision-making in treatment and screening settings, but only one previous trial has formally evaluated DA use in the clinical trial setting. A DA for the Sentinel Node versus Axillary Clearance (SNAC2) trial was developed to help eligible women with a recent diagnosis of breast cancer to decide between: 1) a more invasive, standard treatment with known potential side-effects, or 2) a randomised trial comparing option 1 to a less invasive treatment with fewer side-effects but a possible small, but higher risk of local recurrence. The pilot aimed to obtain evidence on the acceptability, utility and feasibility of the DA in routine trial clinical practice for women considering participation in the SNAC2 trial. Methods: The DA was developed according to International Patient Decision Aid Standards (IPFAS) and discussions with key stakeholders. Twenty women eligible to participate in the SNAC2 trial in New Zealand completed questionnaires assessing: information and involvement preferences, decisional conflict, understanding and attitudes towards SNAC2, anxiety, and general DA feedback. A follow-up telephone interview elicited more detailed feedback about the DA's design, clarity and utility, and assessed women's knowledge about, and attitudes towards SNAC2. Results: Participants indicated good subjective and objective understanding of SNAC2 and reported low decisional conflict and anxiety. They found the DA booklet was helpful when deciding about trial participation; facilitated understanding of the standard information sheet; and provided additional, useful information to the standard trial information sheet. Conclusions: Findings suggest that the DA provided a resource that women found acceptable and helpful in assisting decision-making about SNAC2 trial participation. The pilot process and findings support the generalisability and applicability of the trial DA design to other clinical trial settings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia biopsy female human physician society EMTREE MEDICAL INDEX TERMS anxiety breast cancer clinical practice clinical trial decision making diagnosis feedback system follow up informed consent invasive procedure New Zealand patient questionnaire risk screening side effect telephone interview LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71735455 DOI 10.1111/ajco.12304 FULL TEXT LINK http://dx.doi.org/10.1111/ajco.12304 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 161 TITLE Pathways clinical decision support for appropriate use of key biomarker AUTHOR NAMES Ellis P.G. Lokay K. AUTHOR ADDRESSES (Ellis P.G.; Lokay K.) UPMC CancerCenter, Pittsburgh, United States. CORRESPONDENCE ADDRESS P.G. Ellis, UPMC CancerCenter, Pittsburgh, United States. SOURCE Journal of Clinical Oncology (2014) 32:30 SUPPL. 1. Date of Publication: 20 Oct 2014 CONFERENCE NAME ASCO's Quality Care Symposium 2014 CONFERENCE LOCATION Boston, MA, United States CONFERENCE DATE 2014-10-17 to 2014-10-18 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: UPMC CancerCenter (UPMC) has utilized clinical pathways for almost ten years in an effort to ensure standardization to the evidence based care for its patients. UPMC oncologists participate in the various pathways disease committees that develop and maintain the pathways content and utilize the pathways through a web-based portal in their daily decision making and documentation. The pathways cover not only treatment recommendations but also guidance for work up such as recurrence risk tools (OncoType Dx) for node negative, HER2 negative, ER positive breast cancer who are candidates for chemotherapy. For patients with a low recurrence risk score, the pathways recommends hormonal therapy only, saving the patient both toxicities and costs of chemotherapy where appropriate. Methods: UPMC analyzed its use of chemotherapy in patients with a recurrence risk score of less than 19 through a retrospective review of physician-input data in its Via Pathways Portal for the twelve months ended May 31, 2014. During this time period, the Via Pathways recommended the recurrence risk test for node negative, HER2 negative, ER positive patients. For patients with a low risk score (less than 19), the Via Pathways recommended hormonal therapy only. For those low risk score patients receiving chemotherapy, the physician would document that an Off Pathway decision was being made, indicate the reason for going Off Pathway, and document the actual therapy delivered. Results: For the twelve months ended May 31, 2014, UPMC physicians documented 288 decisions for patient presentation of node negative, HER2 negative, ER positive patients with a recurrence risk score of less than 19. Of these decisions, 99% (n=284) were On Pathway for hormonal therapy. Of the remaining 1%, three (3) were for accrual to a clinical trial and one (1) was Off Pathway for chemotherapy. Conclusions: Pathways are a tool for promoting adherence to evidence based care by oncologists through the use of a point of care decision support system. Pathways have the potential to reduce costs and toxicities of treatment through the evidence based guidance developed by the pathways disease committees and the adherence to such guidance by oncologists utilizing the pathways decision support tool. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biological marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system EMTREE MEDICAL INDEX TERMS breast cancer chemotherapy clinical pathway clinical trial decision making documentation evidence based practice hormonal therapy human oncologist patient physician recurrence risk risk standardization therapy toxicity LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71765382 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 162 TITLE Cancer patients' individually appraised significance of the breast related to the decision for or against a breast reconstruction after mastectomy AUTHOR NAMES Wetzel C.M. Schmidt J.L. Lange K.W. Ortmann O. AUTHOR ADDRESSES (Wetzel C.M.; Schmidt J.L.; Ortmann O.) University Medical Centre Regensburg, Department of Gynaecology and Obstetrics, Regensburg, Germany. (Schmidt J.L.; Lange K.W.) University of Regensburg, Department of Experimental Psychology, Regensburg, Germany. CORRESPONDENCE ADDRESS C.M. Wetzel, University Medical Centre Regensburg, Department of Gynaecology and Obstetrics, Regensburg, Germany. SOURCE Psycho-Oncology (2014) 23 SUPPL. 3 (253). Date of Publication: October 2014 CONFERENCE NAME IPOS 16th World Congress of Psycho-Oncology and Psychosocial Academy CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2014-10-20 to 2014-10-24 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: The decision for or against a breast reconstruction after mastectomy in breast cancer patients is complex. A range of studies postulated that patients' individually appraised relevance of their breast to be an important factor to that decision. Nevertheless, this has hardly been investigated. This study explored the individually perceived significance of the breast in patients with and without breast reconstruction and its correlation with postoperative satisfaction. METHOD: Ten patients without breast reconstruction and ten patients with breast reconstruction after mastectomy participated in the study. The perceived importance of the breast for femininity, attractiveness and sexuality and the pre- and postoperative aesthetic satisfaction of the patients were obtained using a 11-point Likert scale. The group comparisons in these variables were performed using the Mann-Whitney-U test, the correlations of importance of the breast with the difference between preoperative and postoperative satisfaction using the Spearman rank correlation coefficient rs. Individual interviews explored patients' views on the meaning of their breast to them and their experience after mastectomy or breast reconstruction. RESULTS: Patients who had decided for a breast reconstruction rated the importance of their breast to femininity (p = 0.004) and attractiveness (p = 0.037) significantly higher than patients without a reconstruction. There were no differences in the importance to sexuality (p = 0.146). A high individual importance of the breast correlated significantly with a decrease in satisfaction with the breast after reconstruction (rs = -0.652, p = 0.041). The interviews revealed a high relevance of the breast for female identity, “normality” in the social context, the total body image, and for sexuality as an erogenous zone. Difficulties regarding body image and in sexuality were experienced in both groups. CONCLUSIONS: The quantitative findings suggest that patients with an appraisal of a high importance of their breast were more likely to decide for a breast reconstruction. Patients reporting a particularly positive connotation and significance of their breast showed the greatest decrease in satisfaction with the breast after surgery, i.e. the greatest experience of loss. The qualitative data provide evidence for the impact of a mastectomy on various psychosocial variables. A reconstruction may compensate for some but not all of the psychological and interactional problems of breast cancer patients. Specific support regarding decision making and the adaptation after surgery would be desirable. RESEARCH IMPLICATIONS: Research including a greater number of participants and applying a prospective study design is needed for a further validation of these findings. In order to support patients decision- making on breast reconstruction after mastectomy, the development and evaluation of psychoonkological interventions and of standards for medical consultations are required. Furthermore, specific interventions to support coping after mastectomy and breast reconstruction need to be established. CLINICAL IMPLICATIONS: Patients' individual relevance of the breast needs to be assessed and addressed in medical consultations on breast reconstruction as well as in the psycho-oncological support. Potential problems after breast reconstruction, in particular the differences to their natural breast and the related psychological process of adaptation after mastectomy or reconstruction need to be discussed. This is essential to ensure realistic expectations, to prevent dissatisfaction and to improve quality of life and mental health. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast reconstruction cancer patient human mastectomy oncology EMTREE MEDICAL INDEX TERMS adaptation body image breast cancer consultation coping behavior correlation coefficient decision making female femininity identity interview Likert scale mental health patient prospective study quality of life rank sum test satisfaction sexuality social environment study design surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71675477 DOI 10.1111/j.1099-1611.2014.3695 FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2014.3695 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 163 TITLE Do surgeons adopt shared decision-making consultation behaviours when involving women to make decision for breast cancer surgery? AUTHOR NAMES Lam W.W.T. Chan M. Or A. Kwong A. Suen D. Fielding R. AUTHOR ADDRESSES (Lam W.W.T.; Kwong A.; Suen D.; Fielding R.) University of Hong Kong, Hong Kong, Hong Kong. (Chan M.; Or A.) Kwong Wah Hospital, Hong Kong, Hong Kong. CORRESPONDENCE ADDRESS W.W.T. Lam, University of Hong Kong, Hong Kong, Hong Kong. SOURCE Psycho-Oncology (2014) 23 SUPPL. 3 (148). Date of Publication: October 2014 CONFERENCE NAME IPOS 16th World Congress of Psycho-Oncology and Psychosocial Academy CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2014-10-20 to 2014-10-24 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Participation congruence predicts better decision satisfaction in cancer consultations. While most women choosing breast cancer surgery prefer shared decision-making, little is known about if and how surgeons in surgicaloncology consultations promote shared-decision making. This study assessed the utilization by surgeons of shared decision-making in breast surgicaloncology consultations in Hong Kong. METHOD: 283 initial diagnostic-treatment decision consultations between surgical-oncologists and women diagnosed with breast cancer were videorecorded. Shared-decision making behaviours were assessed using the Decision Analysis System for Oncology (DASO) coding system. We also examined its relationship with patient, surgeon and consultation factors. RESULTS: The average consultation duration was 20.2 minutes. Patient/ companions asked an average of 13.8 questions, 98% of which on average targeted clinical topics. Psychosocial-related questions were seldom raised during the consultations. Overall levels of shared decision-making (SDM) behaviours were low. The extent to which a SDM framework was established at the consultation was related to greater consultation duration (p < 0.001), fewer questions raised by patients/companions (p < 0.05), and more than one treatment being offered (p < 0.001). Providing clear and unbiased information at the consultation was significantly related to greater consultation duration (p < 0.001), fewer questions raised by patients/ companions (p < 0.001), and having a female surgeon (p < 0.05). CONCLUSIONS: While shared decision-making has been found to be the preferred form for most women choosing breast cancer surgery, most of the breast surgical consultations observed in this study followed an informed treatment decision-making approach, instead of a shared decision-making approach. When prompted by the patients, the surgeons would explore patients' values and preferences toward the treatment options. In contrast, little attempt was made to tailor the consultation according to patients' participation preference and information preference, encourage comments and questions, provide psychosocial support in consultation, or facilitate patient assimilation of information. RESEARCH IMPLICATIONS: Understanding how surgeons perceive their roles and their patients' expectations of such may help to elucidate why this style of consultation prevails. Qualitative interviews exploring surgeons' perceptions of shared-decision making, and training interventions are needed. CLINICAL IMPLICATIONS: The study findings highlight a need to reinforce the importance of shared decision making in consultations among breast surgical oncologists and develop means to encourage this. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery consultation decision making female human oncology surgeon EMTREE MEDICAL INDEX TERMS breast cardiac resynchronization therapy device diagnosis Hong Kong interview neoplasm patient psychosocial care satisfaction surgical oncologist LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71675311 DOI 10.1111/j.1099-1611.2014.3694 FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2014.3694 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 164 TITLE Helping patients make choices about breast reconstruction: a decision analysis approach AUTHOR NAMES Sun C.S. Cantor S.B. Reece G.P. Fingeret M.C. Crosby M.A. Markey M.K. AUTHOR ADDRESSES (Sun C.S.; Cantor S.B.; Reece G.P.; Fingeret M.C.; Crosby M.A.; Markey M.K.) Austin, Texas From the Department of Biomedical Engineering, The University of Texas at Austin; and the Departments of Plastic Surgery, Behavioral Science, Health Services Research, and Imaging Physics, The University of Texas M. D. Anderson Cancer Center SOURCE Plastic and reconstructive surgery (2014) 134:4 (597-608). Date of Publication: 1 Oct 2014 ISSN 1529-4242 (electronic) ABSTRACT Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision making decision support system psychology EMTREE MEDICAL INDEX TERMS breast tumor (surgery) female human LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25357022 (http://www.ncbi.nlm.nih.gov/pubmed/25357022) PUI L602117829 DOI 10.1097/PRS.0000000000000514 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000514 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 165 TITLE Standardized decision support in next-generation sequencing (NGS) reports of somatic cancer variants AUTHOR NAMES Dienstmann R. Dong F. Borger D. Santagata D.D. Ellisen L.W. Le L.P. Iafrate A.J. AUTHOR ADDRESSES (Dienstmann R.) Sage Bionetworks, Seattle, United States. (Dong F.; Santagata D.D.; Le L.P.; Iafrate A.J.) Massachusetts General Hospital, Harvard Medical School, Molecular Pathology Lab, Boston, United States. (Borger D.; Ellisen L.W.) Massachusetts General Hospital Cancer Center, Boston, United States. CORRESPONDENCE ADDRESS R. Dienstmann, Sage Bionetworks, Seattle, United States. SOURCE Cancer Research (2014) 74:19 SUPPL. 1. Date of Publication: 1 Oct 2014 CONFERENCE NAME 105th Annual Meeting of the American Association for Cancer Research, AACR 2014 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2014-04-05 to 2014-04-09 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Of hundreds to thousands of somatic mutations that exist in each cancer genome, a large number are unique and non-recurrent variants. Many such variants occur in tumor genes that have well-established biological and clinical relevance and are putative targets of molecular therapy, however, most variants are still of unknown significance. Prioritizing and reporting genetic variants identified via NGS technologies remains a major challenge. Methods: Based on a systematic framework for cancer variant annotation/prioritization, we propose a structured molecular pathology report using standardized terminology in order to best inform oncology clinical practice. In parallel with the variant interpretation pipeline, we developed a comprehensive knowledge database (Kdb) that integrates tumor types, genes, variants, response/resistance patterns to approved and experimental agents and PubMed identifiers. Results: As physicians rely heavily on limited subsets of data and frequently apply rules based on strength of evidence in the decision-making process, NGS results are presented in a very discrete manner, avoiding detailed descriptions of each genomic aberration. Reportable variants are grouped in three categories: (i) actionable, which support treatment recommendation, enrollment in clinical trials and/or have prognostic or diagnostic implications; (ii) biologically relevant but not clearly actionable, including novel variants lacking functional preclinical validation in known cancer genes; and (iii) variants of unknown significance. Predictive associations are reported according to tumor type and classified in a hierarchical way based on the strength of evidence: (i) late trials; (ii) early trials; (iii) case reports; and (iv) preclinical data being explored in clinical trials. In our internal Kdb, tumor types with the largest number of emerging predictive associations are acute leukemias, non-small cell lung cancer, brain tumors, melanoma, colorectal, ovarian and breast cancers, comprising more than 100 unique gene - drug interactions. Further interpretation of gene variants requires a team with strong background in cancer biology, careful evaluation of the published literature and ability to match a patient's tumor genotype to clinical trials in the context of multiple aberrations. Conclusions: With large amounts of data being generated as high throughput sequencing assays enter the clinical realm, there is a growing need to better communicate relevant findings in a timely manner while remaining cognizant of the potential consequences of misuse or overinterpretation of genomic information. The scientific knowledge on actionable events should be presented the report, so that physicians can make evidence-based decisions and patients may benefit from treatment with matched targeted agents. We hope that our experience in this process will help other institutions implement similar programs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American cancer research decision support system neoplasm next generation sequencing EMTREE MEDICAL INDEX TERMS acute leukemia assay brain tumor breast cancer case report clinical practice clinical trial (topic) decision making diagnosis drug interaction evidence based practice gene genetic variability genome genotype high throughput sequencing hope human knowledge base laryngeal mask Medline melanoma molecular pathology molecular therapy non small cell lung cancer oncology patient physician pipeline somatic mutation technology tumor gene LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71721305 DOI 10.1158/1538-7445.AM2014-4260 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.AM2014-4260 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 166 TITLE Living with breast cancer: Challenges related with quality of life assessment AUTHOR NAMES Sequeira T. Ferreira P.L. Eberhardt A. Teixeira J. Carvalho L. Silveira A. AUTHOR ADDRESSES (Sequeira T.; Silveira A.) Fernando Pessoa University, Porto, Portugal. (Sequeira T.; Ferreira P.L.; Silveira A.) CEISUC, Coimbra, Portugal. (Ferreira P.L.) Coimbra University, Coimbra, Portugal. (Eberhardt A.; Teixeira J.) Institute of Biomedical Sciences Abel Salazar, Porto, Portugal. (Carvalho L.) Portuguese Institute for Oncology (IPOP), Porto, Portugal. CORRESPONDENCE ADDRESS T. Sequeira, Fernando Pessoa University, Porto, Portugal. SOURCE Psycho-Oncology (2014) 23 SUPPL. 3 (400). Date of Publication: October 2014 CONFERENCE NAME IPOS 16th World Congress of Psycho-Oncology and Psychosocial Academy CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2014-10-20 to 2014-10-24 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Breast cancer most commonly diagnosed cancer among women. Incidence has increased in most Western countries, is age related, the rate of increase in incidence during the premenopausal years is approximately 8-9% per year worldwide. Women before age 40 have slightly poorer prognoses than older women. Many scientific advances in breast cancer - mainly related to diagnosis and therapeutic methods - have improved overall survival rates emphasizing thus the Health Related Quality of Life evaluation needs. METHOD: In order to evaluate HRQOL in breast cancer patient, consecutive patients (n = 569) admitted at the Portuguese Institute for Oncology - Porto - Breast Unit completed the Portuguese versions of a cancer-specific HRQoL instrument, the EORTC QLQ-C30 and the corresponding breast cancer specific module QLQBR23. Questionnaires were completed immediately before consultation as a part of the routine evaluation. Inclusion criteria were ability to understand written and spoken Portuguese and being followed until 5 years after diagnosis. Socio-demographic and clinical variables were also collected by interview or consulting the clinical processes. RESULTS: The mean age was 52.5 ± 10.0 years, 32.5% had a diagnosis prior 1 year and 33.0% have had a diagnosis between 2 and 4 years ago. The functional status dimensions measured by the QLQ-C30 showed high scores, ranged from 65.8 to 80.3 in a 0 to 100 scale. However, the overall HRQoL score 60.5 revealed high levels of symptom burden, especially insomnia, fatigue and financial difficulties. In what concerns breast cancer's specific symptoms, the body image (77.8) and the upset by hair loss (38.3) were the worst symptoms. CONCLUSIONS: A global understanding of HRQoL results highlights a potential for its improvement in these breast cancer patients. Breast cancer patients in 0, I e II stages have a 5-year survival rate higher than 90%. Health related Quality of Life (HRQoL) assessment in routine breast cancer clinical practice has become more common because it provides a unique perspective concerning patient's perceptions during the cancer experience. This knowledge may really optimize healthcare and patient centered strategies. RESEARCH IMPLICATIONS: HRQoL assessment in clinical practice is not common worldwide and represents an increasingly prominent health marker in breast cancer. Researchers have experience in systematic HRQoL assessment implementation. Nurses and physicians involved in this multidisciplinary process use the patient reported outcomes results in clinical practice. HRQoL evaluation is crucial for Portuguese Institute for Oncology - Porto that receives 10,000 cancer patients by year. CLINICAL IMPLICATIONS: Portuguese Institute for Oncology - Porto treats 1000 breast cancer patients per year. It is the major unit in Portugal (number of breast cancer patients admitted) and one of the biggest in Europe. All breast cancer patients can be evaluated since HRQoL assessment implementation. This patient reported outcome may contribute to support clinical decisions, identify unmet needs and can be used in routine care appointments supporting a stepped care model. EMTREE DRUG INDEX TERMS marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer oncology quality of life EMTREE MEDICAL INDEX TERMS body image breast cancer patient clinical practice consultation diagnosis Europe fatigue female functional status hair loss health health care human insomnia interview laryngeal mask model neoplasm nurse overall survival patient physician Portugal prognosis questionnaire scientist survival rate LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71675714 DOI 10.1111/j.1099-1611.2014.3697 FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2014.3697 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 167 TITLE Comparison of high-resolution 3D X-ray microCT and tomosynthesis imaging: A breast phantom study AUTHOR NAMES Singh J.M. Bui A.H. Michaelson J.S. AUTHOR ADDRESSES (Singh J.M.; Bui A.H.; Michaelson J.S.) Massachusetts General Hospital, Cambridge, United States. CORRESPONDENCE ADDRESS J.M. Singh, Massachusetts General Hospital, Cambridge, United States. SOURCE Cancer Research (2014) 74:19 SUPPL. 1. Date of Publication: 1 Oct 2014 CONFERENCE NAME 105th Annual Meeting of the American Association for Cancer Research, AACR 2014 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2014-04-05 to 2014-04-09 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT We have demonstrated the feasibility of imaging a mammographic accreditation phantom using high-resolution 3D X-ray microCT as an alternative to tomosynthesis. While both X-ray microCT and tomosynthesis produce high-resolution 3D images, tomosynthesis requires compression of the specimen and yields asymmetrical voxels, resulting in high spatial resolution along two axes and more limited resolution along the third axis. MicroCT imaging, however, does not require compression and provides uniform, high resolution in all directions. The limited angular range of tomosynthesis is advantageous for pre-operative screening tasks, while the increased spatial and full angular range of microCT has been increasingly applied to the assessment of surgically excised breast tissue during breast conserving surgery. Rapid and accurate assessment of excised tissues is desirable to minimize risk of recurrence, which is highest in the first two years after surgery. We employed a 35-80 kV, 7.6-15W scan protocol in X-ray microCT to image the breast phantom. We also tested the ability to detect the phantom target features (2.00-0.16 mm) in long (25 minute) and short (5-6 minute) scans. The phantom was designed to simulate the X-ray attenuation of a slab of compressed human breast consisting of glandular and adipose tissue. Both X-ray microCT and tomosynthesis were able to capture the smallest features (0.16 mm) of the phantom. Both long- and short-duration microCT scans enabled detection of the smallest (0.16mm) features of the phantom. The results obtained here suggest that (1) microCT could be used, as an alternative to tomosynthesis, to identify and localize features on the order of 100-200 microns in ex vivo tumor specimens and (2) microCT could be used to detect features of this size on an intra-operative basis (in 5-6 minute scans). This study shows the feasibility of using microCT for intra-operative 3D examination of surgical specimens, an application which could aid clinical decision-making in assessment of excision margins. Additionally, if high-resolution 3D imaging techniques can distinguish between features of tumor and non-tumor areas of tissues, as is suggested by these results, then these imaging modalities could hold promise for identification of biomarkers and elucidation of the gross anatomy of breast tumor types, such as ductal carcinoma in situ. There is not yet an accepted phantom for testing the detection limits of 3D high-resolution X-ray imaging. The phantom used here is a validated tool for calibration of mammography instruments, but it seems that digital X-ray imaging technologies, such as microCT, can quite easily capture the features of this phantom. Therefore, while microCT performed as well as tomosynthesis in detection of features in this breast phantom study, there is a need for the development and validation of new phantoms to assess the ability of tomosynthesis and microCT to resolve features in the <100 micron range. EMTREE DRUG INDEX TERMS biological marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast cancer research imaging phantom X ray EMTREE MEDICAL INDEX TERMS accreditation adipose tissue attenuation breast tumor clinical decision making compression ex vivo study examination excision human intraductal carcinoma limit of detection mammography neoplasm partial mastectomy radiography risk screening surgery technology tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71721344 DOI 10.1158/1538-7445.AM2014-4299 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.AM2014-4299 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 168 TITLE Individualized risk of surgical-site infection: an application of the breast reconstruction risk assessment score AUTHOR NAMES Kim J.Y. Khavanin N. Jordan S.W. ver Halen J.P. Mlodinow A.S. Bethke K.P. Khan S.A. Hansen N.M. Losken A. Fine N.A. AUTHOR ADDRESSES (Kim J.Y.; Khavanin N.; Jordan S.W.; ver Halen J.P.; Mlodinow A.S.; Bethke K.P.; Khan S.A.; Hansen N.M.; Losken A.; Fine N.A.) Chicago, Ill.; Memphis, Tenn.; and Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery and the Lynn Sage Comprehensive Breast Center, Northwestern University, Feinberg School of Medicine; the Department of Plastic and Reconstructive Surgery, Baptist Cancer Center/Vanderbilt Ingram Cancer Center; and the Division of Plastic and Reconstructive Surgery, Emory University Hospital SOURCE Plastic and reconstructive surgery (2014) 134:3 (351e-362e). Date of Publication: 1 Sep 2014 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Risk factors for surgical-site infection following beast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level.METHODS: Mastectomies with immediate reconstruction (n = 16,069) from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. A multiple logistic regression model was created for postoperative surgical-site infection. Hosmer-Lemeshow, C statistic, and Brier score were computed to assess model performance. Bootstrap analysis validated the model.RESULTS: A robust, validated risk model for surgical-site infection was developed using 11 covariates. The model Hosmer-Lemeshow p value was 0.371, the Brier score was 0.0357, and the C statistic was 0.682 (optimism-corrected C statistic, 0.678). The distribution of individual risks demonstrated a positive skew. Population-derived risk underestimated or overestimated individual risk by at least 1.5-fold in nearly one-fifth of all patients.CONCLUSIONS: The breast reconstruction risk assessment score risk calculator for surgical-site infection mitigates the potentially inaccurate interpolation of population-based risk to individual patients. The authors concomitantly developed an online interface-accessible by patients and surgeons alike-to quantify a patient's risk for surgical-site infection, better informing evidence-based decisions and managing patient expectations.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision support system personalized medicine EMTREE MEDICAL INDEX TERMS adult aged evaluation study factual database female human mastectomy middle aged receiver operating characteristic reproducibility risk assessment risk factor statistical model surgical infection (etiology, prevention) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24814422 (http://www.ncbi.nlm.nih.gov/pubmed/24814422) PUI L601965761 DOI 10.1097/PRS.0000000000000439 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000439 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 169 TITLE Breast cancer patient preferences for adjuvant radiation therapy postlumpectomy: Whole-breast irradiation versus partial breast irradiation-preliminary results AUTHOR NAMES McGuffin M. Szumacher E. DiProspero L. Feldman-Stewart D. Harth T. Pignol J. Chow E.L. Vesprini D. Rakovitch E. Doherty M. Lee J. Kiss A. Presutti R. AUTHOR ADDRESSES (McGuffin M.; Harth T.; Presutti R.) Sunnybrook Health Sciences Centre, Toronto, Canada. (Szumacher E.; DiProspero L.; Pignol J.; Vesprini D.; Rakovitch E.; Doherty M.; Lee J.; Kiss A.) Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. (Feldman-Stewart D.) Queen's University, Kingston, Canada. (Chow E.L.) Sunnybrook Heath Science Centre, University of Toronto, Toronto, Canada. CORRESPONDENCE ADDRESS M. McGuffin, Sunnybrook Health Sciences Centre, Toronto, Canada. SOURCE International Journal of Radiation Oncology Biology Physics (2014) 90:1 SUPPL. 1 (S233). Date of Publication: 1 Sep 2014 CONFERENCE NAME 56th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-09-14 to 2014-09-17 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): The standard regimen of radiation therapy following lumpectomy is whole breast irradiation (WBI) to the entire breast including the lumpectomy cavity and all the surrounding normal breast tissue. Recently, there has been increased interest in partial breast irradiation (PBI) as an alternative to WBI. However, the preferences of patients with early breast cancer as to what type of radiation therapy regimen post lumpectomy they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI and to identify important factors for patients when making their treatment decision. Materials/Methods: Based on our previous study of early stage breast cancer patient information needs, the relevant literature and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients with early breast cancer who were referred for adjuvant radiation therapy at a large cancer center in Canada were invited to participate. Women ≥40 years of age with a new histological diagnosis of ductal carcinoma in-situ or invasive breast carcinoma treated with breast conserving surgery showing clear margins for non-invasive and invasive disease and negative axillary nodes were eligible. Descriptive statistics were used to describe all variables of interest. The proportion of patients preferring WBI or PBI was summarized using 95% confidence intervals. A chi-square analysis was carried out to assess the bivariate relationships between treatment preference in relation to demographic variables as well as Likert scale responses from the questionnaire. A logistic regression model was run to assess the multivariate relationship between potentially important variables (p < 0.2) and treatment preference. Results: Out of 55 patients enrolled in the study, 18 preferred PBI and 37 preferred WBI post lumpectomy. Factors rated as important by patients in making their decision included convenience [PBI = 12(67%), WBI = 23(64%)], financial factors [PBI=8(44%), WBI=16(43%)], radiation dose to the breast [PBI = 13(76%), WBI = 31(84%)], invasiveness [PBI = 11(61%), WBI = 31(89%), p = 0.02], recurrence rate [PBI = 18(100%), WBI = 37(100%)], survival [PBI = 18(100%), WBI = 36(97%)], effectiveness [PBI=17(94%), WBI=37(100%)], standard method of treatment [PBI = 10(56%), WBI = 34(94%), p = 0.001] and radiation dose to surrounding organs [PBI = 15(83%), WBI = 36(97%)]. Conclusions: Our preliminary data shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. Of the items listed in the survey, choosing the standard method of treatment and invasiveness were the only statistically significant factor influencing patient preference in the decision making process. A detailed analysis of all decisional preferences between WBI and PBI will be presented. (Table Presented). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer cancer patient human irradiation oncology patient preference radiotherapy society EMTREE MEDICAL INDEX TERMS adjuvant therapy breast carcinoma Canada cancer center chi square test confidence interval consensus decision making female histology intraductal carcinoma Likert scale logistic regression analysis model partial mastectomy patient patient information questionnaire radiation dose recurrence risk statistics survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71623766 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 170 TITLE Decision time for clinical decision support systems AUTHOR NAMES O'Sullivan D. Fraccaro P. Carson E. Weller P. AUTHOR ADDRESSES (O'Sullivan D., Dympna.O'Sullivan.1@city.ac.uk) Centre for Health Informatics, School of Informatics, City University London, Northampton Square, London EC1V 0HB, United Kingdom. (Fraccaro P.; Weller P.) Centre for Health Informatics, City University London, London, United Kingdom. (Carson E.) Department of Systems Science, Centre for Health Informatics, City University London, London, United Kingdom. CORRESPONDENCE ADDRESS D. O'Sullivan, Centre for Health Informatics, School of Informatics, City University London, Northampton Square, London EC1V 0HB, United Kingdom. Email: Dympna.O'Sullivan.1@city.ac.uk SOURCE Clinical Medicine, Journal of the Royal College of Physicians of London (2014) 14:4 (338-341). Date of Publication: 1 Aug 2014 ISSN 1473-4893 (electronic) 1470-2118 BOOK PUBLISHER Royal College of Physicians ABSTRACT Clinical decision support systems are interactive software systems designed to help clinicians with decision-making tasks, such as determining a diagnosis or recommending a treatment for a patient. Clinical decision support systems are a widely researched topic in the computer science community, but their inner workings are less well understood by, and known to, clinicians. This article provides a brief explanation of clinical decision support systems and some examples of real-world systems. It also describes some of the challenges to implementing these systems in clinical environments and posits some reasons for the limited adoption of decision-support systems in practice. It aims to engage clinicians in the development of decision support systems that can meaningfully help with their decisionmaking tasks and to open a discussion about the future of automated clinical decision support as a part of healthcare delivery. © Royal College of Physicians 2014. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical decision making clinical decision support system decision support system EMTREE MEDICAL INDEX TERMS article artificial intelligence artificial neural network breast cancer cancer adjuvant therapy cancer diagnosis clinical classification clinical practice data mining electronic medical record emergency health service health care delivery human human computer interaction information seeking ischemic heart disease law suit learning algorithm logistic regression analysis medical informatics medical information system personalized medicine physician practice guideline prognosis prostate cancer psychiatric diagnosis quality control reminder system scoring system screening test sleep disordered breathing statistical analysis support vector machine taxonomy telemedicine treatment contraindication EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014547491 MEDLINE PMID 25099829 (http://www.ncbi.nlm.nih.gov/pubmed/25099829) PUI L373770840 DOI 10.7861/clinmedicine.14-4-338 FULL TEXT LINK http://dx.doi.org/10.7861/clinmedicine.14-4-338 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 171 TITLE Seeking balance: decision support needs of women without cancer and a deleterious BRCA1 or BRCA2 mutation AUTHOR NAMES Underhill M.L. Crotser C.B. AUTHOR ADDRESSES (Underhill M.L.; Crotser C.B.) The Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Avenue, L522, Boston, MA, 02115, USA, meghanl_underhill@dfci.harvard.edu SOURCE Journal of genetic counseling (2014) 23:3 (350-362). Date of Publication: 1 Jun 2014 ISSN 1573-3599 (electronic) ABSTRACT Recommendations for women with a deleterious BRCA1 or BRCA2 gene mutation include complex medical approaches related to cancer risk reduction and detection. Current science has not yet fully elucidated decision support needs that women face when living with medical consequences associated with known hereditary cancer risk. The purpose of this study was to describe health communication and decision support needs in healthy women with BRCA1/2 gene mutations. The original researchers completed an interpretive secondary qualitative data analysis of 23 phenomenological narratives collected between 2008 and 2010. The Ottawa Decision Support and Patient Centered Communication frameworks guided the study design and analysis. Women described a pattern wherein breast and ovarian cancer risk, health related recommendations and decisions, and personal values were prioritized over time based on life contexts. Knowing versus acting on cancer risk was not a static process but an ongoing balancing act of considering current and future personal and medical values, further compounded by the complexity of recommendations. Women shared stories of anticipatory, physical and psychosocial consequences of the decision making experience. The findings have potential to generate future research questions and guide intervention development. Importantly, findings indicate a need for ongoing, long-term, support from genetics professionals and decision support interventions, which challenges the current practice paradigm. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making mutation psychology tumor suppressor gene tumor suppressor gene EMTREE MEDICAL INDEX TERMS female genetics human neoplasm LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24271037 (http://www.ncbi.nlm.nih.gov/pubmed/24271037) PUI L602072031 DOI 10.1007/s10897-013-9667-2 FULL TEXT LINK http://dx.doi.org/10.1007/s10897-013-9667-2 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 172 TITLE Why women are choosing mastectomy: Influences beyond the surgeon AUTHOR NAMES Covelli A.M. Baxter N.N. Fitch M. Wright F.C. AUTHOR ADDRESSES (Covelli A.M.; Baxter N.N.; Fitch M.; Wright F.C.) University of Toronto, Toronto, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada CORRESPONDENCE ADDRESS A.M. Covelli, SOURCE Journal of Clinical Oncology (2014) 32:15 SUPPL. 1. Date of Publication: 20 May 2014 CONFERENCE NAME 2014 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-05-30 to 2014-06-03 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Rates of unilateral (UM) and contralateral prophylactic mastectomy (CPM) for early stage breast cancer (ESBC) have been increasing. Surgical decision making is comprised of the surgeon, the patient and the external environment. We sought the perspectives of patients who chose UM +/- CPM and treating surgeons to understand why mastectomy rates have been increasing. Methods: We completed a grounded theory qualitative study to examine the surgeon's practice and the patient's decision making that resulted in the choice for UM +/- CPM. Purposive sampling identified women across Toronto, Canada who were suitable 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, this continued until data saturation was reached. Constant comparative analysis identified key ideas. Results: 29 patients and 45 surgeons completed interviews. The dominant theme was 'Desire for control', women strived to improve their cancer outcomes by undergoing more extensive surgery. Surgeons described BCT and UM as equivalent treatment options for ESBC and frequently recommended BCT. Despite this, surgeons described women initiating the request for UM+CPM. In this average risk population CPM was discouraged by the surgeons, describing no survival advantage. The most influential factor in a woman's request for CPM was their personal cancer experiences with family and friends and not the surgical consultation. A previous negative experience with breast cancer translated into an overestimated risk of recurrence, contralateral cancerand subsequent mortality. Women chose UM+CPM to ensure they would 'never go through this again.' Despite feeling confident in their choice most women had ongoing issues with disturbed skin sensation, cosmesis and body image. Conclusions: Factors, especially a previous cancer experience, are extremely influential when women choose UM+/-CPM. As many women had long term pain and issues with cosmesis after UM +/- CPM, we suggest women may benefit from education including exposure to other patients' post-operative concerns to aid in their decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female human mastectomy oncology society surgeon EMTREE MEDICAL INDEX TERMS body image breast breast cancer Canada community consultation decision making education environment exposure friend grounded theory interview mortality neoplasm pain patient patient decision making population qualitative research risk sampling semi structured interview skin sensation surgery survival therapy United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71522454 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 173 TITLE Exploring decision making about neoadjuvant chemotherapy for early breast cancer AUTHOR NAMES Zdenkowski N. Butow P.N. Fewster S. Beckmore C. Wells K. Forbes J.F. Boyle F.M. AUTHOR ADDRESSES (Zdenkowski N.; Butow P.N.; Fewster S.; Beckmore C.; Wells K.; Forbes J.F.; Boyle F.M.) Australia and New Zealand Breast Cancer Trials Group, Newcastle, Australia; University of Sydney, Sydney, Australia; Breast Cancer Network Australia, Camberwell, Australia; Faculty of Health, University of Newcastle, Newcastle, Australia; Patricial Rigchie Centre for Cancer Care and Research, North Sydney NSW, Australia CORRESPONDENCE ADDRESS N. Zdenkowski, SOURCE Journal of Clinical Oncology (2014) 32:15 SUPPL. 1. Date of Publication: 20 May 2014 CONFERENCE NAME 2014 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-05-30 to 2014-06-03 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: For women who have been diagnosed with early stage breast cancer, the option of receiving neoadjuvant chemotherapy (NACT) adds complexity to the decision-making process. A high level of involvement in decisions about breast cancer management is associated with improved decisional outcomes. Little is known about how women make the decision about whether to have NACT. We aimed to explore women's information needs, decision control preference, reasons for and against the approach, and satisfaction with the decision. Methods: An email invitation was sent to members of the Breast Cancer Network Australia Review and Survey Group who had been diagnosed with early stage breast cancer. Women who had previously been offered neoadjuvant or adjuvant chemotherapy for early breast cancer took part in a semi-structured interview about their experience with NACT. Data were analysed thematically using qualitative methodology. Results: Twenty-two consecutive women were interviewed, at which point no new major themes were identified, and no further interviews took place. Thirteen women had received NACT, 6 had declined an offer of NACT, and 3 were not offered it. Clinicians were the major source of information about NACT. Participants endorsed the neoadjuvant approach for the following reasons: aiming to downstage from mastectomy to breast conserving surgery; as part of a clinical trial protocol; to delay surgery; for prognostic purposes; and to avoid any delays to chemotherapy. Barriers included a lack of written consumer information and unawareness of neoadjuvant chemotherapy as a valid treatment. Women trusted their clinicians' recommendations, which led to allowed high levels of satisfaction with the decision and subsequent treatment they received. Conclusions: Women were unable to become fully informed about NACT, in order to participate in the decision. In order to derive decisional satisfaction, women put a high level of trust in their treating clinician. Based on these results, a patient decision aid is under development for women considering NACT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant chemotherapy breast cancer decision making oncology society EMTREE MEDICAL INDEX TERMS Australia chemotherapy clinical trial consumer e-mail female human interview mastectomy methodology partial mastectomy patient satisfaction semi structured interview surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71523373 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 174 TITLE Problem list documentation and surveillance mammography: Can meaningful use be useful? AUTHOR NAMES Maloney F.L. Elfiky A. Wright A. AUTHOR ADDRESSES (Maloney F.L.; Elfiky A.; Wright A.) Partners HealthCare, Wellesley, MA; Brigham and Women's Hospital/Harvard University, Boston, MA; Brigham and Women's Hospital/Harvard Medical School, Boston, MA CORRESPONDENCE ADDRESS F.L. Maloney, SOURCE Journal of Clinical Oncology (2014) 32:15 SUPPL. 1. Date of Publication: 20 May 2014 CONFERENCE NAME 2014 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-05-30 to 2014-06-03 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: The electronic health record problem list (ePL) plays important roles in clinical decision support and communication with consequent improved care delivery. Despite established national guidelines, 20-55% of breast cancer survivors do not receive routine surveillance imaging. We established the correlation between ePL documentation and surveillance imaging for breast cancer (BC) survivors per ASCO guidelines. Methods: The Dana-Farber/Partners Cancer Center Registry was used to identify women diagnosed with BC at Dana-Farber/Brigham and Women's Hospital (DF/BWH) between 1/1/01 to 12/31/06. We excluded subjects with age > 85, male gender, bilateral mastectomy, or stage IV disease at diagnosis. Additional exclusions for each analysis year were diagnosis of a new primary, disease recurrence, death or loss to follow-up. Using information integration and protocol-based checking we then queried the Partners Healthcare system to determine whether a five year annual surveillance mammogram or MRI was obtained beginning 18 months after diagnosis in accordance with published ASCO guidelines. An analysis was conducted to determine whether demographic disparities, AJCC stage, or structured ePL documentation of BC attributed to differences in surveillance mammography. Results: During the study period 4,068 women were diagnosed with BC at DF/BWH. During each 1-year post-therapy surveillance period, an average of 75.3% women received surveillance imaging. Among the 2,030 for whom data was analyzed for all 5 years of follow-up, 4.7% had no annual surveillance imaging, 7.9% had 1, 6.3% had 2,7.3% had 3, 18.4% had 4, and 55.4% had all 5. After adjusting for age, language, race, income, marital status and AJCC stage, the ePL documentation of BC was significantly associated with surveillance imaging (p=0.02). Compared to patients who have no problem list documentation of BC, those who had it added at any time during the study period were more likely to have surveillance imaging all five years (OR 1.40; 95% CI 1.05-1.86). Conclusions: Electronic documentation of BC is significantly associated with 5-years of surveillance imaging in accordance with published guidelines, even after controlling for demographic variables. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) documentation mammography meaningful use criteria oncology society EMTREE MEDICAL INDEX TERMS breast cancer cancer center cancer survivor death decision support system diagnosis electronic medical record female follow up gender health care system hospital human imaging income interpersonal communication language male marriage mastectomy nuclear magnetic resonance imaging patient recurrent disease register therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71523686 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 175 TITLE Management of mastectomy skin flap necrosis in autologous breast reconstruction AUTHOR NAMES Nykiel M. Sayid Z. Wong R. Lee G.K. AUTHOR ADDRESSES (Nykiel M.; Sayid Z.; Wong R.; Lee G.K.) From the Division of Plastic Surgery, Stanford University, Stanford, CA SOURCE Annals of plastic surgery (2014) 72 Supplement 1 (S31-S34). Date of Publication: 1 May 2014 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: Mastectomy skin flap necrosis is a significant problem in the autologous breast reconstruction. The necrosis may create unsightly scarring, produce contour irregularities, and deform the breast mound. This may lead to a poor reconstruction and patient satisfaction. Most importantly, the development and treatment of mastectomy skin flap necrosis can delay further oncologic treatment.We performed a retrospective chart review of all patients undergoing autologous breast reconstruction in the past 5 years to examine our incidence and treatment of mastectomy skin flap necrosis. We then used these data to create a management algorithm for mastectomy skin flap necrosis. The goals of this algorithm were as follows: (1) to not delay further oncologic treatment, (2) to expedite the healing time while minimizing patient risk, and (3) to create an aesthetically pleasing breast reconstruction.MATERIALS AND METHODS: A retrospective chart review from 2008 to 2013 was performed of all autologous breast reconstruction at our institution. We then analyzed our data and patient outcomes and developed a treatment algorithm.RESULTS: We identified 204 patients who underwent autologous free flap breast reconstruction that was performed by the senior author (G.K.L.). Our incidence of mastectomy skin necrosis was 30%. There was no delay in adjuvant oncologic treatment for any of our patients. The development of mastectomy skin necrosis was significant for patients with diabetes (P=0.03), current tobacco use (P=0.04), and body mass index (P=0.01). The time for wound healing was prolonged in patients with a high body mass index (P=0.04). Regression analysis of wound size showed full-thickness wounds greater than 6 cm benefited from operative closure.CONCLUSIONS: Our incidence of mastectomy skin necrosis was 30%. Despite our high incidence mastectomy skin necrosis, we had no delays in adjuvant oncologic treatment. Retrospective data analysis allowed us to then develop a management algorithm for mastectomy skin necrosis. We feel it is advantageous to the patient and the reconstructive outcome to heal the breast wounds in the acute phase (within 3 weeks); and with regression analysis, we found full-thickness wounds greater than 6 cm benefit from operative intervention. Finally, patients requiring adjuvant oncologic treatment should be healed as quickly as possible so they may continue on with their oncologic care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mastectomy pathology procedures transplantation EMTREE MEDICAL INDEX TERMS adult algorithm autotransplantation breast breast reconstruction breast tumor (surgery) debridement decision support system evaluation study female free tissue graft human middle aged necrosis (epidemiology, etiology, surgery) postoperative complication (epidemiology, surgery) retrospective study skin transplantation surgery treatment outcome wound closure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24667879 (http://www.ncbi.nlm.nih.gov/pubmed/24667879) PUI L601990689 DOI 10.1097/SAP.0000000000000174 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000174 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 176 TITLE The current clinical value of the DCIS Score AUTHOR NAMES Wood W.C. Alvarado M. Buchholz D.J. Hyams D. Hwang S. Manders J. Park C. Solin L.J. White J. Willey S. AUTHOR ADDRESSES (Wood W.C.; Alvarado M.; Buchholz D.J.; Hyams D.; Hwang S.; Manders J.; Park C.; Solin L.J.; White J.; Willey S.) SOURCE Oncology (Williston Park, N.Y.) (2014) 28 Supplement 2 (C2, 1-8, C3). Date of Publication: 1 May 2014 ISSN 0890-9091 ABSTRACT The management of ductal carcinoma in situ (DCIS) can be controversial. Widespread adoption of mammographic screening has made DCIS a more frequent diagnosis, and increasingly smaller, lower-grade lesions are being detected. DCIS is commonly treated with breast-conserving surgery and radiation. However, there is greater recognition that acceptable cancer control outcomes can be achieved for some patients with breast-conserving surgery alone, with radiotherapy reserved for those at higher risk of in-breast recurrence. The primary clinical dilemma is that there are currently no reliable clinicopathologic features that accurately predict which patients will have a recurrence, but risk stratification is an area of active research. Molecular profiling has the potential to assess recurrence risk based on the individual patient's tumor biology and guide treatment decisions. The DCIS Score is a 12-gene assay intended to support personalized treatment planning for patients with DCIS following local excision. It provides information on local failure risk independent of traditional clinicopathologic features. Our group of expert breast surgeons and radiation oncologists met in December 2013 at the San Antonio Breast Cancer Symposium to discuss current controversies in DCIS management and determine the potential value of the DCIS Score in managing these situations. We concluded that the DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making. EMTREE DRUG INDEX TERMS genetic marker tumor marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system genetic screening genetics personalized medicine EMTREE MEDICAL INDEX TERMS adjuvant therapy breast tumor (therapy) disease free survival female genetic marker genetic predisposition human intraductal carcinoma (therapy) mastectomy mortality pathology patient selection phenotype predictive value risk assessment risk factor secondary time treatment outcome tumor recurrence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25375000 (http://www.ncbi.nlm.nih.gov/pubmed/25375000) PUI L601924479 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 177 TITLE A single-blinded RCT of the use of bolus in post mastectomy irradiation in breast cancer AUTHOR NAMES Sapienza L.G. Aiza A.R. Lins L.A.N. Trigo C.C. Fogaroli R.C. Maia M.A.C. AUTHOR ADDRESSES (Sapienza L.G.; Aiza A.R.; Lins L.A.N.; Trigo C.C.; Fogaroli R.C.; Maia M.A.C.) AC Camargo Cancer Center, Radiation Oncology, São Paulo, Brazil. CORRESPONDENCE ADDRESS L.G. Sapienza, AC Camargo Cancer Center, Radiation Oncology, São Paulo, Brazil. SOURCE Radiotherapy and Oncology (2014) 111 SUPPL. 1 (S64). Date of Publication: 2014 CONFERENCE NAME 2014 Annual Conference of the European Society for Radiotherapy and Oncology, ESTRO 33 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2014-04-04 to 2014-04-08 ISSN 0167-8140 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Purpose/Objective: There is a lack of clinical data about the use of bolus (tissue equivalent material) in post mastectomy irradiation in breast cancer patients treated with tangent photons fields. We designed a trial to evaluate toxicity, clinical impact and economic expenses of different frequencies of use of the bolus (NCT01925651). Materials and Methods: Fifty-four consecutive patients were recruited and are being followed prospectively. The inclusion criteria are breast cancer with histopathological diagnosis, more than 18 years old and no history of previous thoracic irradiation. All patients signed an informed consent form. The patients are categorized in high risk or low risk, based on the extension of the tumor to the skin in clinical and pathological staging. The low risk patients are then randomized to no use of bolus or use of a 0.5cm bolus in alternated day. The high risk ones are randomized to use a 0.5cm bolus daily or in alternated days. The patients are examined weekly to evaluate the grade of radiodermatitis according to Common Terminology Criteria for Adverse Events (CTCAE v4.0), the local care products, and treatment interruptions due to dermatitis. The evaluation was done by a nurse specialized in radiodermitis, without knowledge of patient randomization. for the statistical analysis weused the Fisher exact test. Results: With the accrual of 54 patients (july-november 2013), we present the results of the 29 patients with final follow-up until this interim analysis (november 2013). two patients removed the informed consent, being excluded from the study and not randomized. All patients had at least grade 1 radiodermatitis. Three patients in the no bolus group (3/7) and three patients in alternated bolus group have grade 2 radiodermatitis (p=0.3185). Comparing alternated bolus with daily bolus, no patient in first group developed grade 3 toxicity (0/16), but 66% (4/6) developed G3 radiodermatitis with daily bolus (p=0.0021). The patients with G3 radiodematitis were treated with a hidrocolloid curative and had the skin ulcers resolved in three weeks. No patient interrupted treatment until this analysis. Conclusions: There is a significant increase in G3 radiodermatitis in patients treated with daily 0.5cm bolus (p=0.0021). This translated in more expenses with curatives and patient suffering. No increase of interruption of treatment was detected until this interim analysis. The decision of indicating a higher frequency of bolus should be carefully evaluated due to the lack of evidence of clinical benefit in local control and the increased toxicity to the patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer European irradiation mastectomy oncology radiotherapy society EMTREE MEDICAL INDEX TERMS cancer patient clinical study dermatitis diagnosis Fisher exact test follow up human informed consent low risk patient neoplasm nurse patient photon radiation dermatitis randomization risk skin skin ulcer staging statistical analysis tissues toxicity LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71889434 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 178 TITLE Feasibility of preoperative volumetric-modulated arc therapy for early stage breast cancer AUTHOR NAMES Bota K. Gaede S. Karnas S. Wong E. Yaremko B. Lock M. AUTHOR ADDRESSES (Bota K.) London Regional Cancer Program, Radiation Therapy, London, Canada. (Gaede S.; Karnas S.) London Regional Cancer Program, Medical Physics, London, Canada. (Wong E.) University of Western Ontario, Physics and Astronomy, London, Canada. (Yaremko B.; Lock M.) London Regional Cancer Program, Radiation Oncology, London, Canada. CORRESPONDENCE ADDRESS K. Bota, London Regional Cancer Program, Radiation Therapy, London, Canada. SOURCE Radiotherapy and Oncology (2014) 111 SUPPL. 1 (S136). Date of Publication: 2014 CONFERENCE NAME 2014 Annual Conference of the European Society for Radiotherapy and Oncology, ESTRO 33 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2014-04-04 to 2014-04-08 ISSN 0167-8140 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Purpose/Objective: Currently, early stage breast cancer is treated with a surgical lumpectomy followed by whole breast tangential radiation therapy in 25 fractions and chemotherapy. Employing preoperative stereotactic body radiation therapy (SBRT) may have similar overall survival, toxicity and local control with the added benefit of improved cosmesis and shorter duration of radiation treatment time. Through dosimetric evaluation we aim to demonstrate the feasibility of preoperative single fraction partial breast irradiation (PBI) using Volumetric-Modulated Arc Therapy (VMAT) for early stage breast cancer patients. Materials and Methods: Fourteen planning scenarios were generated based on four post-operative breast patient simulation CTs. A dose of 21Gy was prescribed to a spherical contour representing an early stage tumour volume within breast tissue. Each gross tumour volume (GTV) varied in laterality and location and had a mean volume of 6cc. SBRT plans were generated using 6MV partial arcs. Multiple plans were evaluated for each patient by varying the GTV to planning target volume (PTV) expansion and by systematically varying the location of the GTV with respect to the skin surface. Results: All cases achieved at least 21Gy to 95% of the PTV. Maximum skin doses varied between 7-9.5 Gy and 9-14 Gy for cases where the GTV is 2 cm and 1.5 cm from the skin surface, respectively. Cases where the GTV was less than 1cm from the skin surface resulted in PTV expansion into the skin contour, thus increasing skin dose beyond tolerance for surgical healing. PTV margins expanded beyond 5mm resulted in suboptimal dose distributions and increased dose to the normal surrounding tissue. Cases where the GTV of 6cc or less was between 1.5cm and 2cm from the skin also satisfied normal tissue constraints including normal breast, heart, chest wall and lung. Conclusions: Preoperative breast irradiation using VMAT is feasible and maximum skin doses vary with tumour depth. Definitive maximum skin dose limits have yet to be established in the literature, although 6Gy has been recommended in the intra-operative radiotherapy setting. This dosimetric evaluation has demonstrated that maximum skin doses between 7-14Gy are achievable when partial arc VMAT techniques are used and a standardized tumour depth is implemented. Skin doses are a growing concern among surgeons and preliminary insight on what doses can be achieved will aid in the decision to implement preoperative single fraction SBRT in clinic. A prospective Phase I trial has been proposed based on the findings of this study. EMTREE DRUG INDEX TERMS vesicular monoamine transporter EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer European oncology radiotherapy society therapy EMTREE MEDICAL INDEX TERMS breast cancer patient chemotherapy healing heart hemispheric dominance hospital human irradiation lung neoplasm overall survival partial mastectomy patient phase 1 clinical trial planning radiation dose distribution skin skin surface stereotactic body radiation therapy surgeon teaching thorax wall tissues toxicity tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71889996 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 179 TITLE Decision analysis - Effects of prophylactic mastectomy on life expectancy among women with nonhereditary breast cancer AUTHOR NAMES Steward L.T. Chang S.-H. Colditz G.A. Margenthaler J.A. AUTHOR ADDRESSES (Steward L.T.; Chang S.-H.; Colditz G.A.; Margenthaler J.A.) Surgery, Washington University, School of Medicine, St. Louis, United States. CORRESPONDENCE ADDRESS L.T. Steward, Surgery, Washington University, School of Medicine, St. Louis, United States. SOURCE Annals of Surgical Oncology (2014) 21 SUPPL. 2 (115). Date of Publication: April 2014 CONFERENCE NAME 15th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2014-04-30 to 2014-05-04 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objective: Recent data suggest an increased rate of mastectomy with contralateral prophylactic mastectomy (CPM) despite potential eligibility for breast conservation. Previous research suggested that this practice may be occurring because women believe that CPM will prolong their survival. We sought to determine the impact of contralateral prophylactic mastectomy on life expectancy and quality-adjusted life expectancy. Methods: In a decision analysis model, we compared bilateral mastectomy with unilateral mastectomy/breast conservation surgery among women (ages, 30 - 70) with nonhereditary breast cancer with early-stage disease (I and II). We used data from published literature about the incidence of contralateral breast cancer, locoregional recurrence, metastatic breast cancer, and survival to estimate their effects on life expectancy. We also used data from the literature of utility estimates of bilateral mastectomy, locoregional disease, and metastatic disease in order to calculate their effects on quality-adjusted life-years. Results: We calculated that bilateral mastectomy offered extremely modest gains in life expectancy, ranging from 0.08 to 0.87 years. However, bilateral mastectomy was associated with losses in quality-adjusted life-years, ranging from 0.39 to 0.272 years. Bilateral mastectomy provided the largest gain in life expectancy in young women with early-stage, hormone receptor-positive disease. Older women derived the least benefit from bilateral mastectomy. (See table.). Conclusion: Among women with nonhereditary breast cancer, bilateral mastectomy provides minimal gain in life expectancy with associated loss in quality-adjusted life-years. EMTREE DRUG INDEX TERMS hormone receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer female human life expectancy mastectomy society surgeon EMTREE MEDICAL INDEX TERMS metastasis metastatic breast cancer model quality adjusted life year surgery survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71448815 DOI 10.1245/s10434-014-3672-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-014-3672-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 180 TITLE Setting a Research Agenda for Ductal Carcinoma in Situ That Meets the Current Need for Change AUTHOR NAMES Esserman L. Alvarado M. AUTHOR ADDRESSES (Esserman L., Laura.Esserman@ucsfmedctr.org; Alvarado M.) Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, United States. CORRESPONDENCE ADDRESS L. Esserman, Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, United States. Email: Laura.Esserman@ucsfmedctr.org SOURCE Annals of Internal Medicine (2014) 160:7 (511-512). Date of Publication: 1 Apr 2014 ISSN 1539-3704 (electronic) 0003-4819 BOOK PUBLISHER American College of Physicians EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer research intraductal carcinoma (diagnosis) EMTREE MEDICAL INDEX TERMS anxiety breast carcinoma breast cell cancer growth cancer patient cancer prognosis carcinoma in situ cell structure chemoprophylaxis comparative study decision making decision support system editorial family history human hyperplasia intervention study lifestyle modification mastectomy medical decision making observational study partial mastectomy pathologist precancer priority journal quality of life research priority risk factor risk reduction tumor invasion validation study wide excision EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014228360 MEDLINE PMID 24566896 (http://www.ncbi.nlm.nih.gov/pubmed/24566896) PUI L372737009 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 181 TITLE Strategies for reducing regional variation in the use of surgery: A systematic review AUTHOR NAMES Reames B.N. Shubeck S.P. Birkmeyer J.D. AUTHOR ADDRESSES (Reames B.N., breames@umich.edu; Birkmeyer J.D.) Center for Healthcare Outcomes and Policy, University of Michigan, Bldg 16, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States. (Reames B.N., breames@umich.edu; Shubeck S.P.; Birkmeyer J.D.) Department of Surgery, University of Michigan, Ann Arbor, MI, United States. CORRESPONDENCE ADDRESS B.N. Reames, Center for Healthcare Outcomes and Policy, University of Michigan, Bldg 16, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States. Email: breames@umich.edu SOURCE Annals of Surgery (2014) 259:4 (616-627). Date of Publication: April 2014 ISSN 0003-4932 1528-1140 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVE:: To review the literature evaluating the effect of practice guidelines and decision aids on use of surgery and regional variation. BACKGROUND:: The use of surgical procedures varies widely across geographic regions. Although practice guidelines and decision aids have been promoted for reducing variation, their true effectiveness is uncertain. METHODS:: Studies evaluating the influence of clinical practice guidelines or consensus statements, shared decision making and decision aids, or provider feedback of comparative utilization, on rates of surgical procedures were identified through literature searches of Ovid MEDLINE, EMBASE, and Web of Science. RESULTS:: A total of 1946 studies were identified and 27 were included in the final review. Of the 12 studies evaluating implementation of guidelines, 6 reported a significant effect. Those examining overall population-based rates had mixed effects, but all studies evaluating procedure choice described at least a small increase in use of recommended therapy. Three of 5 studies examining the effect of guidelines on regional variation reported a significant reduction after dissemination. Of the 15 studies examining decision aids, 5 revealed significant effects. Many studies of decision aids reported decreases in population-based procedure rates. Nearly all studies evaluating the impact of decision aids on procedure choice reported increases in rates of less invasive procedures. Only one study of decision aids assessed changes in regional variation and found mixed results. CONCLUSIONS:: Both practice guidelines and decision aids have been proven effective in many clinical contexts. Expanding the clinical scope of these tools and eliminating barriers to implementation will be essential to further efforts directed toward reducing regional variation in the use of surgery. © 2013 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) geographic distribution regional variation surgical technique EMTREE MEDICAL INDEX TERMS breast surgery cancer surgery consensus ear surgery human invasive procedure medical decision making nose surgery partial mastectomy practice guideline priority journal procedures prostatectomy quality control review systematic review throat surgery tonsillectomy transurethral resection EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014176635 MEDLINE PMID 24240626 (http://www.ncbi.nlm.nih.gov/pubmed/24240626) PUI L372580296 DOI 10.1097/SLA.0000000000000248 FULL TEXT LINK http://dx.doi.org/10.1097/SLA.0000000000000248 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 182 TITLE Development and pilot testing of a patient decision aid for treatment decision in ductal carcinoma in situ AUTHOR NAMES Berger-Höger B. Gerlach A. AUTHOR ADDRESSES (Berger-Höger B.; Gerlach A.) University of Hamburg, MIN-Faculty Unit of Health Sciences and Education, Hamburg, Germany. CORRESPONDENCE ADDRESS B. Berger-Höger, University of Hamburg, MIN-Faculty Unit of Health Sciences and Education, Hamburg, Germany. SOURCE European Journal of Cancer (2014) 50 SUPPL. 2 (S173). Date of Publication: March 2014 CONFERENCE NAME 9th European Breast Cancer Conference, EBCC-9 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2014-03-19 to 2014-03-21 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: After the implementation of a screening programme for breast cancer, the number of diagnoses of ductal carcinoma in situ (DCIS) increased in Germany. Overdiagnoses and overtreatment are thus assumed to occur. To prevent decisional conflict patients should be involved in the treatment decision by shared decision making (SDM). Support for weighing the options in an individualised manner is given by decision aids (DA) and evidence based patient information. A DA for treatment decision in DCIS was developed and pilot tested following the UK Medical Research Council's guidance for the development and evaluation of complex interventions. Materials and Methods: Existent DA on the topic of DCIS were searched in addition to a systematic literature search. Relevant treatment options for DCIS were identified to generate the content of the DA. Focus group interviews (N = 3, with 14 participants) and semi-structured expertinterviews (N = 3) with women who were not affected by breast cancer, were conducted. The interviews were transcribed and analysed with MAXQDA using qualitative content analysis. In addition, an expert-review by patient representatives (N = 2), experts in patient information (N = 3) and clinical experts in diagnosis and treatment of DCIS (N = 3) was obtained. The results were discussed by the authors and continuously included in the revision of the DA. Results: No DA on the topic of DCIS was identified in German language. Main contents of the DA are information on the disease, its natural course, the treatment options, including the option of doing nothing, and their risks and benefits, as well as a guidance for the decision making process. Risk communication was supported by pictograms and bar graphs. Participants appraised marginal notes as helpful. In the revision process, figures in the DA were reduced so that they were clearly arranged and understood by the women. Above all, women requested further information on how to influence disease progress by their own lifestyle. An appropriate chapter was developed. The experts postulated careful use of the term 'cancer' related to DCIS because of the unclear natural course of disease. Conclusions: Useful feedback from participants and experts, guided the revision. Furthermore the DA will be tested in a RCT that evaluates the efficacy of a complex SDM-programme in breast cancer centres in Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer human intraductal carcinoma patient EMTREE MEDICAL INDEX TERMS cancer center content analysis decision making diagnosis evidence based practice feedback system female Germany hospital patient information processing interpersonal communication interview language lifestyle medical research neoplasm patient information risk screening United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71404097 DOI 10.1016/S0959-8049(14)70101-7 FULL TEXT LINK http://dx.doi.org/10.1016/S0959-8049(14)70101-7 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 183 TITLE Implementing family health history risk stratification in primary care: Impact of guideline criteria on populations and resource demand AUTHOR NAMES Orlando L.A. Wu R.R. Beadles C. Himmel T. Buchanan A.H. Powell K.P. Hauser E.R. Henrich V.C. Ginsburg G.S. AUTHOR ADDRESSES (Orlando L.A., lorlando@duke.edu) Department of Medicine and Center for Personalized and Precision Medicine, Duke University, United States. (Wu R.R.) Duke University Department of Medicine, United States. (Himmel T.) Duke Institute for Genome Sciences and Policy, United States. (Powell K.P.) Cone Health System, Greensboro, NC, United States. (Hauser E.R.) Department of Medicine, United States. (Hauser E.R.; Ginsburg G.S.) Duke University, United States. (Henrich V.C.) University of North Carolina at Greensboro, United States. (Beadles C.; Buchanan A.H.) CORRESPONDENCE ADDRESS L.A. Orlando, 3475 Erwin Rd, 2nd floor Aesthetics Bldg, Durham, NC 27705, United States. Email: lorlando@duke.edu SOURCE American Journal of Medical Genetics, Part C: Seminars in Medical Genetics (2014) 166:1 (24-33). Date of Publication: March 2014 ISSN 1552-4868 1552-4876 (electronic) BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT The Genomic Medicine Model aims to facilitate patient engagement, patient/provider education of genomics/personalized medicine, and uptake of risk-stratified evidence-based prevention guidelines using MeTree, a patient-facing family health history (FHH) collection and clinical decision support (CDS) program. Here we report the number of increased risk (above population-level risk) patients identified for breast/ovarian cancer, colon cancer, hereditary syndrome risk, and thrombosis; the prevalence of FHH elements triggering increased-risk status; and the resources needed to manage their risk. Study design: hybrid implementation-effectiveness study of adults with upcoming well-visits in 2 primary care practices in Greensboro, NC. Participants: 1,184, mean age=58.8, female=58% (N=694), non-white=20% (N=215). Increased Risk: 44% (N=523). Recommendations: genetic counseling=26% (N=308), breast MRI=0.8% (N=10), breast chemoprophylaxis=5% (N=58), early/frequent colonoscopies=19% (N=221), ovarian cancer screening referral=1% (N=14), thrombosis testing/counseling=2.4% (N=71). FHH elements: 8 FHH elements lead to 37.3% of the increased risk categorizations (by frequency): first-degree-relative (FDR) with polyps age ≥60 (7.1%, N=85), three relatives with Lynch-related cancers (5.4%, N=65), FDR with polyps age <60 (5.1%, N=61), three relatives on same side of family with same cancer (4.9%, N=59), Gail score ≥1.66% (4.9%, N=58), two relatives with breast cancer (one ≤age 50) (4.1%, N=49), one relative with breast cancer ≤age 40 (4.1%, N=48), FDR with colon cancer age ≥60 (1.7%, N=20). MeTree identifies a high percentage of individuals in the general primary care population needing non-routine risk management/prevention for the selected conditions. Implementing risk-stratification in primary care will likely increase demand for related-resources, particularly colon screening and GC. Understanding the prevalence of FHH elements helps predict resource needs and may aid in guideline development. © 2014 Wiley Periodicals, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) family health history risk family history primary medical care EMTREE MEDICAL INDEX TERMS adult article breast cancer cancer risk cancer screening clinical decision making colon cancer decision support system evidence based medicine female genetic counseling genetic disorder genomics hereditary nonpolyposis colorectal cancer hereditary tumor high risk population human major clinical study male middle aged ovary cancer personalized medicine practice guideline prevalence priority journal relative risk assessment risk management thrombosis EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014188990 MEDLINE PMID 24616329 (http://www.ncbi.nlm.nih.gov/pubmed/24616329) PUI L53049253 DOI 10.1002/ajmg.c.31388 FULL TEXT LINK http://dx.doi.org/10.1002/ajmg.c.31388 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 184 TITLE Anxiety, depression, and quality of life in German ambulatory breast cancer patients AUTHOR NAMES Schleife H. Sachtleben C. Finck Barboza C. Singer S. Hinz A. AUTHOR ADDRESSES (Schleife H.; Sachtleben C.) Department of Internal Medicine, Helios Kliniken, Borna, Germany. (Finck Barboza C.) Universidad de Los Andes, Bogotá, Colombia. (Singer S.; Hinz A., andreas.hinz@medizin.uni-leipzig.de) Department of Medical Psychology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany. CORRESPONDENCE ADDRESS A. Hinz, Department of Medical Psychology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany. Email: andreas.hinz@medizin.uni-leipzig.de SOURCE Breast Cancer (2014) 21:2 (208-213). Date of Publication: March 2014 ISSN 1340-6868 1880-4233 (electronic) BOOK PUBLISHER Springer Japan, 1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo, Japan. ABSTRACT Background: The aim of the study was to determine the predictors of health-related quality of life in ambulatory breast cancer patients. Methods: A total of 107 breast cancer outpatients were tested with the Hospital Anxiety and Depression Scale (HADS) and the quality of life instrument EORTC QLQ-C30. Furthermore, the degree of social support and shared decision making (SDM) were assessed. Results: In nearly all domains of EORTC QLQ-C30 the patients reported worse mean scores than the general population in a clinically significant range, especially in the symptom scales. Therapy-related factors and the degree of SDM contributed only marginally to quality of life. Social support, however, proved to be predictive of better mental health and better quality of life in many domains. Conclusion: Irrespective of the therapy, the social network of the patients should be activated to help the patients to cope with the disease. However, the findings do not support the idea that enhanced SDM would have beneficial effects on mental health. © 2012 The Japanese Breast Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety breast cancer depression quality of life EMTREE MEDICAL INDEX TERMS adult aged article cancer patient controlled study coping behavior decision making female Germany Hospital Anxiety and Depression Scale human major clinical study priority journal quality of life index self report social network social support weight reduction EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014153267 MEDLINE PMID 22661104 (http://www.ncbi.nlm.nih.gov/pubmed/22661104) PUI L52049349 DOI 10.1007/s12282-012-0378-6 FULL TEXT LINK http://dx.doi.org/10.1007/s12282-012-0378-6 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 185 TITLE Psychosocial and cultural reasons for delay in seeking help and nonadherence to treatment in Indonesian women with breast cancer: A qualitative study AUTHOR NAMES Iskandarsyah A. de Klerk C. Suardi D.R. Soemitro M.P. Sadarjoen S.S. Passchier J. AUTHOR ADDRESSES (Iskandarsyah A., a.iskandarsyah@erasmusmc.nl) Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, Netherlands. (Iskandarsyah A., a.iskandarsyah@erasmusmc.nl) Department of Clinical Psychology, VU University, Amsterdam, Netherlands. (Iskandarsyah A., a.iskandarsyah@erasmusmc.nl) Department of Clinical Psychology, Padjadjaran University, Bandung, Indonesia. (de Klerk C.) Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, Netherlands. (Suardi D.R.; Soemitro M.P.) Department of Surgical Oncology, Hasan Sadikin Hospital, Bandung, Indonesia. (Sadarjoen S.S.) Department of Clinical Psychology, Padjadjaran University, Indonesia. (Passchier J.) Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, Netherlands. (Passchier J.) Department of Clinical Psychology, VU University, Netherlands. CORRESPONDENCE ADDRESS A. Iskandarsyah, Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Netherlands. Email: a.iskandarsyah@erasmusmc.nl SOURCE Health Psychology (2014) 33:3 (214-221). Date of Publication: March 2014 ISSN 0278-6133 1930-7810 (electronic) BOOK PUBLISHER American Psychological Association Inc., 750 First Street, NE Washington, United States. ABSTRACT Objective: The aim of this study was to explore reasons for delay in seeking medical help and nonadherence to treatment in Indonesian women with breast cancer. Method: Semistructured interviews were conducted by purposive sampling, using a consecutive sample of 50 breast cancer patients who were treated at the Outpatient Surgical Oncology Clinic of Hasan Sadikin Hospital in Bandung, Indonesia. Interviews were recorded, transcribed verbatim, and coded using qualitative software. Codes were merged into main themes that were subsequently mapped onto the study's aim. Results: Eight main themes concerning reasons for delay in seeking medical help and treatment nonadherence emerged, namely: lack of awareness and knowledge, cancer beliefs, treatment beliefs, financial problems, emotional burden, severe side effects, paternalistic style of communication, and unmet information needs. Conclusion: This study has identified several modifiable psychosocial and cultural factors related to delay in seeking help and nonadherence to treatment in breast cancer patients. We suggest that the provision of extensive information through media campaigns, treatment decision aids, and caregiver and patient education are needed to change the illness behaviors of Indonesian breast cancer patients. © 2013 American Psychological Association. EMTREE DRUG INDEX TERMS antineoplastic agent (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy) cultural factor help seeking behavior social psychology therapy delay treatment refusal EMTREE MEDICAL INDEX TERMS adult advanced cancer aged article awareness cancer chemotherapy cancer patient clinical article dizziness (side effect) doctor patient relation educational status emotionality family history fatigue (side effect) female finance hair loss (side effect) health belief health insurance housewife human interpersonal communication loss of appetite (side effect) marriage medical information middle aged nausea (side effect) pain (side effect) patient education qualitative research quantitative study semi structured interview sleep disorder (side effect) theoretical model unemployment widow EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014172812 MEDLINE PMID 23339645 (http://www.ncbi.nlm.nih.gov/pubmed/23339645) PUI L372569249 DOI 10.1037/a0031060 FULL TEXT LINK http://dx.doi.org/10.1037/a0031060 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 186 TITLE Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? AUTHOR NAMES Lam W.W.T. Kwok M. Chan M. Hung W.K. Ying M. Or A. Kwong A. Suen D. Yoon S. Fielding R. AUTHOR ADDRESSES (Lam W.W.T., wwtlam@hku.hk; Kwok M.; Yoon S.; Fielding R.) School of Public Health, The University of Hong Kong, Hong Kong. (Chan M.; Hung W.K.; Ying M.; Or A.) The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. (Kwong A.; Suen D.) Breast Surgery Division, Department of Surgery, The University of Hong Kong, Hong Kong. CORRESPONDENCE ADDRESS W.W.T. Lam, Centre for Psycho-Oncological Research and Training, Division of Behavioural Health, School of Public Health, The University of Hong Kong, WMW Mong Block, Faculty of Medicine Bldg., 21 Sassoon Rd., Pokfulam, Hong Kong. Email: wwtlam@hku.hk SOURCE Patient Education and Counseling (2014) 94:2 (243-249). Date of Publication: February 2014 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction. Methods: Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret. Results: Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration ( p < 0.001), more than one treatment being offered ( p < 0.001), and fewer questions raised by patients/companions ( p < 0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients' feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret. Conclusion: These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction. Practice implications: The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons. © 2013 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery consultation medical decision making patient participation EMTREE MEDICAL INDEX TERMS article Chinese decision support system doctor patient relation female human major clinical study patient decision making patient satisfaction priority journal questionnaire surgeon videorecording EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014059913 MEDLINE PMID 24316055 (http://www.ncbi.nlm.nih.gov/pubmed/24316055) PUI L52901607 DOI 10.1016/j.pec.2013.11.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2013.11.006 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 187 TITLE Safety of tissue expander/implant versus autologous abdominal tissue breast reconstruction in postmastectomy breast cancer patients: a systematic review and meta-analysis. AUTHOR NAMES Tsoi B. Ziolkowski N.I. Thoma A. Campbell K. O'Reilly D. Goeree R. AUTHOR ADDRESSES (Tsoi B.) Hamilton, Ontario, Canada; and Warsaw, Poland From the Department of Clinical Epidemiology and Biostatistics, the Division of Plastic Surgery, Department of Surgery, and the Surgical Outcomes Research Center, Department of Surgery, McMaster University; Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare Hamilton; and the Second Department of General, Vascular, and Oncologic Surgery, Medical University of Warsaw. (Ziolkowski N.I.; Thoma A.; Campbell K.; O'Reilly D.; Goeree R.) CORRESPONDENCE ADDRESS B. Tsoi, Hamilton, Ontario, Canada; and Warsaw, Poland From the Department of Clinical Epidemiology and Biostatistics, the Division of Plastic Surgery, Department of Surgery, and the Surgical Outcomes Research Center, Department of Surgery, McMaster University; Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare Hamilton; and the Second Department of General, Vascular, and Oncologic Surgery, Medical University of Warsaw. SOURCE Plastic and reconstructive surgery (2014) 133:2 (234-249). Date of Publication: Feb 2014 ISSN 1529-4242 (electronic) ABSTRACT Breast reconstruction after mastectomy for breast cancer should be informed by evidence-based knowledge, such as complication rates. The authors compared the safety of tissue expander/implant reconstruction with that of autologous abdominal tissue reconstruction. A systematic literature review identified peer-reviewed studies published from January of 2000 to October of 2012 that compared tissue expander/implant against autologous abdominal tissue reconstruction in the MEDLINE, EMBASE, Cochrane Library, PubMed, and ProQuest Dissertations and Theses databases. Two reviewers independently screened all reports and selected the relevant articles using specific inclusion criteria. Data were extracted from the relevant articles using a standardized abstraction form. Fourteen observational studies were identified that included more than 3000 reconstructed breasts. Significant differences were found between these two approaches. The relative risk associated with reconstructive failure favored autologous abdominal tissue (relative risk, 0.14; 95 percent CI, 0.06 to 0.32; I = 0 percent). Surgical-site infection was significantly lower in autologous abdominal tissue reconstruction compared with tissue expander/implant (relative risk, 0.37; 95 percent CI, 0.25 to 0.55; I = 0 percent), although skin or flap necrosis was higher in autologous abdominal tissue reconstruction compared with tissue expander/implant (relative risk, 2.79; 95 percent CI, 1.87 to 4.17). Studies were of low to moderate quality according to the Newcastle-Ottawa scale. This study suggests that tissue expander/implant reconstruction has a higher risk of reconstructive failure and surgical-site infection compared with autologous abdominal tissue reconstruction. With the lack of long-term safety studies on different approaches to breast reconstruction, additional long-term comparative studies are needed to support evidence-based decision-making. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal fat breast implant (adverse drug reaction) breast reconstruction breast tumor (surgery) mastectomy tissue expander (adverse drug reaction) EMTREE MEDICAL INDEX TERMS comparative study female human meta analysis methodology review transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 24469159 (http://www.ncbi.nlm.nih.gov/pubmed/24469159) PUI L372661936 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 188 TITLE The Effect of margin status on local recurrence and cost analysis using a decision tree model AUTHOR NAMES Abe S.E. Hill J.S. Carpenter K. Han Y. Symanowski J. White R. AUTHOR ADDRESSES (Abe S.E.; Hill J.S.; Carpenter K.; Han Y.; Symanowski J.; White R.) Carolinas Medical Center, Levine Cancer Institute, Charlotte, United States. CORRESPONDENCE ADDRESS S.E. Abe, Carolinas Medical Center, Levine Cancer Institute, Charlotte, United States. SOURCE Annals of Surgical Oncology (2014) 21:1 SUPPL. 1 (S9). Date of Publication: February 2014 CONFERENCE NAME 67th Annual Cancer Symposium of the Society of Surgical Oncology CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2014-03-12 to 2014-03-15 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Introduction: The definition of an adequate surgical margin for breast conservation therapy (BCT) continues to be controversial. Studies have not consistently demonstrated that reexcision to obtain wider margins, with its attendant increased cost, results in decreased local recurrence (LR). We designed a decision tree model to analyze LR and surgical costs based on margin status. Methods:A decision tree model was developed for the management of margins after BCT for invasive cancer. Data from 10 published studies (3,930 subjects) was used to determine the proportion of patients who fall into 3 margin status groups: positive, close (≤2mm) and negative (>2mm). Data from 15 studies (6,014 subjects) was used to determine 5 year LR rate for each group. The model assumed 140,000 initial BCT (230,000 new breast cancer patients/year with ∼60% BCT), that all patients with a positive margin underwent reexcision, that only one reexcision was required to obtain negative margins, and that mastectomy was performed after LR. Simulation cycles compared a strategy where all patients with close margins underwent reexcision (Strategy 1) versus one where they did not (Strategy 2). Number needed to treat was calculated comparing these strategies. Surgical costs were estimated using 2013 Medicare reimbursement rates. Results: In our model, 19.6% had positive margins, 21.8% had close margins and 58.7% had negative margins. Strategy 1 resulted in overall LR of 5.1%, with total surgical cost of $45,243,228 (reexcision $37,932,875, mastectomy $7,310,353). Strategy 2 resulted in overall LR of 5.5%, with total surgical cost of $25,826,684 (reexcision $17,974,347, mastectomy $7,852,337). Excess surgical cost associated with Strategy 1 was $19,416,544. Number of reexcisions in close margin patients needed to prevent one recurrence was 57. Conclusion: In our model, LR did not markedly differ between the two strategies. However, the strategy to obtain margin widths >2mm resulted in total excess cost of ∼$20 million. This does not include hospital costs, the cost of surgical complications after reexcision, nor the reality of multiple reexcisions or mastectomy performed to obtain negative margins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost benefit analysis decision tree model neoplasm oncology society EMTREE MEDICAL INDEX TERMS breast breast cancer hospital cost human mastectomy medicare patient postoperative complication reimbursement simulation therapy tumor invasion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71432314 DOI 10.1245/s10434-013-3474-8 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-3474-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 189 TITLE Psychosocial factors relating to the decision against or in favour for prophylactic surgery AUTHOR NAMES Wassermann K. Rhiem K. Schmutzler R. AUTHOR ADDRESSES (Wassermann K.; Rhiem K.; Schmutzler R.) Uniklinik Köln, Zentrum f. Familiären Brust- und Eierstockkrebs, Köln, Germany. CORRESPONDENCE ADDRESS K. Wassermann, Uniklinik Köln, Zentrum f. Familiären Brust- und Eierstockkrebs, Köln, Germany. SOURCE Oncology Research and Treatment (2014) 37 SUPPL. 1 (111). Date of Publication: February 2014 CONFERENCE NAME 31. Deutscher Krebskongress iKON - intelligente Konzepte in der Onkologie CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2014-02-19 to 2014-02-22 ISSN 2296-5270 BOOK PUBLISHER S. Karger AG ABSTRACT BRCA-Mutations are related to an increased risk for breast and ovarian cancer. The breast cancer risk ranges from 30-80% and can be reduced to approx. 3% by prophylactic mastectomy. Therefore women with a BRCA-mutation often deal with the question whether a prophylactic surgery or the intensified surveillance programme is a reasonable solution. The decision does not only affect health, cancer incidence and survival, but is entangled with everyday life. Data for side effects and the long term outcome of a mastectomy are still poor. To elucidate the psychological implications of such a decision we have initiated a research project supported by the BMG (Bundesministerium für Gesundheit). We offer psychological counselling and testing to mutation carriers in addition to the medical non-directive risk consulting. The goal is to support a sustainable decision that considers all aspects of the woman's individual situation. The women get validated questionnaires to analyse mental state, personality aspects and life events and are asked about their decision process and the support needed. Preliminary Results: From 68 participants about 48% consider prophylactic mastectomy independent from their current health status and independent of their cancer risk situation. 28% of women with breast cancer and 21% of the healthy women reveal increased anxiety scores (HADS >8) before the medical consulting. 68% of the women with an increased HADS-anxiety score tend to pMTX to reduce their fear. After consultation 92% of women feel well informed (n = 39) and 85% feel they can make a well-considered decision. 92% feel very satisfied/ satisfied with the support. 80% recommend other mutation carriers to undergo psychological counselling before making a decision. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) social psychology surgery EMTREE MEDICAL INDEX TERMS anxiety breast breast cancer cancer incidence cancer risk consultation counseling decision making fear female health health status Hospital Anxiety and Depression Scale human implantable cardiac monitor life event mastectomy mental health mutation ovary cancer personality questionnaire risk side effect survival LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71731975 DOI 10.1159/000360634 FULL TEXT LINK http://dx.doi.org/10.1159/000360634 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 190 TITLE The effect of narrative information in a publicly available patient decision aid for early-stage breast cancer AUTHOR NAMES Shaffer V.A. Tomek S. Hulsey L. AUTHOR ADDRESSES (Shaffer V.A.; Tomek S.; Hulsey L.) a Department of Health Sciences and Department of Psychological Sciences , University of Missouri SOURCE Health communication (2014) 29:1 (64-73). Date of Publication: 2014 ISSN 1532-7027 (electronic) ABSTRACT This study was designed to (1) evaluate the effect of narratives used in a popular, publicly available patient decision aid for early-stage breast cancer on hypothetical treatment decisions and attitudes toward the decision aid and (2) explore the moderating effects of participant numeracy, electronic health literacy and decision-making style. Two hundred women were asked to imagine that they had been diagnosed with early-stage breast cancer and viewed one of two versions of a video decision aid for early-stage breast cancer. The narrative version of the aid included stories from breast cancer survivors; the control version had no patient stories. After viewing the video decision aid, participants made a hypothetical treatment choice between lumpectomy with radiation and mastectomy, answered several questions about their decision, and evaluated the quality of the decision aid. Participants received $100 for completing the study. The two conditions differed in their motivations for the treatment decision and perceptions of the aid's trustworthiness and emotionality but showed no differences in preferences for surgical treatments or evaluations of the decision aid's quality. However, the impact of patient narratives was moderated by numeracy and electronic health literacy. Higher levels of numeracy were associated with decreased decisional confidence and lower ratings of trustworthiness for the decision aid in the narrative video condition but not in the control video condition. In contrast, higher levels of electronic health literacy were associated with increased decisional confidence and greater perceptions of trustworthiness and credibility of the decision aid in the narrative video condition but not the control video condition. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system patient preference verbal communication EMTREE MEDICAL INDEX TERMS adult aged breast tumor (surgery) controlled study female human middle aged pathology psychology randomized controlled trial United States videorecording young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23384155 (http://www.ncbi.nlm.nih.gov/pubmed/23384155) PUI L603537609 DOI 10.1080/10410236.2012.717341 FULL TEXT LINK http://dx.doi.org/10.1080/10410236.2012.717341 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 191 TITLE Survival outcomes after contralateral prophylactic mastectomy: A decision analysis AUTHOR NAMES Portschy P.R. Kuntz K.M. Tuttle T.M. AUTHOR ADDRESSES (Portschy P.R.; Tuttle T.M., tuttl006@umn.edu) Department of Surgery, University of Minnesota, 420 Delaware St, Mayo Mail Code 195, Minneapolis, United States. (Kuntz K.M.) Division of Health Policy and Management, University of Minnesota, Minneapolis, United States. CORRESPONDENCE ADDRESS T.M. Tuttle, Department of Surgery, University of Minnesota, 420 Delaware St, Mayo Mail Code 195, Minneapolis, United States. SOURCE Journal of the National Cancer Institute (2014) 106:8 Article Number: dju160. Date of Publication: 1 Aug 2014 ISSN 1460-2105 (electronic) 0027-8874 BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background: Contralateral prophylactic mastectomy (CPM) rates have substantially increased in recent years and may reflect an exaggerated perceived benefit from the procedure. The objective of this study was to evaluate the magnitude of the survival benefit of CPM for women with unilateral breast cancer.Methods: We developed a Markov model to simulate survival outcomes after CPM and no CPM among women with stage I or II breast cancer without a BRCA mutation. Probabilities for developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and age-specific mortality rates were estimated from published studies. We estimated life expectancy (LE) gain, 20-year overall survival, and disease-free survival with each intervention strategy among cohorts of women defined by age, estrogen receptor (ER) status, and stage of cancer.Results: Predicted LE gain from CPM ranged from 0.13 to 0.59 years for women with stage I breast cancer and 0.08 to 0.29 years for those with stage II breast cancer. Absolute 20-year survival differences ranged from 0.56% to 0.94% for women with stage I breast cancer and 0.36% to 0.61% for women with stage II breast cancer. CPM was more beneficial among younger women, stage I, and ER-negative breast cancer. Sensitivity analyses yielded a maximum 20-year survival difference with CPM of only 1.45%.Conclusions: The absolute 20-year survival benefit from CPM was less than 1% among all age, ER status, and cancer stage groups. Estimates of LE gains and survival differences derived from decision models may provide more realistic expectations of CPM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (prevention, surgery) cancer survival contralateral breast cancer (prevention) contralateral prophylactic mastectomy mastectomy prophylactic surgical procedure EMTREE MEDICAL INDEX TERMS age cancer mortality controlled study disease free survival female human life expectancy overall survival primary tumor priority journal probability review simulation survival time treatment outcome EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015113523 MEDLINE PMID 25031308 (http://www.ncbi.nlm.nih.gov/pubmed/25031308) PUI L604794028 DOI 10.1093/jnci/dju160 FULL TEXT LINK http://dx.doi.org/10.1093/jnci/dju160 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 192 TITLE Impact of prophylactic mastectomy in BRCA1/2 mutation carriers AUTHOR NAMES Rhiem K. Schmutzler R. AUTHOR ADDRESSES (Rhiem K.; Schmutzler R., rita.schmutzler@uk-koeln.de) Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, Köln, Germany. CORRESPONDENCE ADDRESS R. Schmutzler, Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, Köln, Germany. SOURCE Breast Care (2014) 9:6 (385-389). Date of Publication: 21 Jan 2014 ISSN 1661-3805 (electronic) 1661-3791 BOOK PUBLISHER S. Karger AG ABSTRACT Unlike the general decrease in invasive oncologic care, the trend for prophylactic bilateral mastectomy in healthy women and prophylactic contralateral mastectomy in women with unilateral breast cancer is steadily rising. This is even more surprising when considering that for e.g. prophylactic contralateral mastectomy no clear survival benefit has been demonstrated so far. The decision-making process around risk-reducing surgery may be influenced by several conflicting parameters such as the patient's fears and desire to achieve a survival advantage, the surgeon's financial motivations, or the oncologist's paternalistic approach to the above trend. Physicians should support their patients throughout the decision-making process, guide them through the dense fog of information, and encourage them to reconsider all options and alternatives before embarking on an irreversible surgical intervention. Healthy and diseased women should be comprehensively informed about their absolute individual risks for cancer, the benefits and harms of the surgery, alternative preventive strategies, and last but not least the competing risks of preceding carcinomas and cancer in general. Within the framework of non-directive counseling in the specialized centers of the German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC), decision-making aids are being developed with grants from the Federal Ministry of Health and the German Cancer Aid to support women in making conclusive and satisfactory decisions. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE DRUG INDEX TERMS carrier protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mastectomy prophylactic surgical procedure EMTREE MEDICAL INDEX TERMS breast cancer (prevention, surgery) cancer prevention cancer risk cancer survival decision making gene mutation genetic screening genotype phenotype correlation human priority journal protein polymorphism review risk benefit analysis risk reduction CAS REGISTRY NUMBERS carrier protein (80700-39-6) EMBASE CLASSIFICATIONS Cancer (16) Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015680228 PUI L601523156 DOI 10.1159/000369592 FULL TEXT LINK http://dx.doi.org/10.1159/000369592 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 193 TITLE Decision aids for people facing health treatment or screening decisions AUTHOR NAMES Stacey D. Légaré F. Col N.F. Bennett C.L. Barry M.J. Eden K.B. Holmes-Rovner M. Llewellyn-Thomas H. Lyddiatt A. Thomson R. Trevena L. Wu J.H.C. AUTHOR ADDRESSES (Stacey D., dstacey@uottawa.ca) School of Nursing, University of Ottawa, Ottawa, Canada. (Légaré F.) Centre de Recherche du CHU de Québec (CRCHUQ), Hôpital St- François d'Assise, Canada. (Col N.F.) Center of Excellence in Neuroscience and Department of Medicine, University of New England, Biddeford, United States. (Bennett C.L.; Wu J.H.C.) Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. (Barry M.J.) Informed Medical Decisions Foundation, Boston, United States. (Eden K.B.) Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, United States. (Holmes-Rovner M.) Center for Ethics and Humanities in the Life Sciences, Michigan State University College of HumanMedicine, East Lansing, United States. (Llewellyn-Thomas H.) The Dartmouth Center for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, United States. (Lyddiatt A.) Ingersoll, Canada. (Thomson R.) Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom. (Trevena L.) The University of Sydney, Sydney, Australia. CORRESPONDENCE ADDRESS D. Stacey, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Canada. Email: dstacey@uottawa.ca SOURCE Cochrane Database of Systematic Reviews (2014) 2014:1 Article Number: CD001431. Date of Publication: 2014 ISSN 1469-493X (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Background Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. Objectives To assess the effects of decision aids for people facing treatment or screening decisions. Search methods For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). Selection criteria We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. Data collection and analysis Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were: A) 'choice made' attributes; B) 'decision-making process' attributes. Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. Main results This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each. Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choicemade' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies). A) Criteria involving 'choice made' attributes: Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13). B) Criteria involving 'decision-making process' attributes: Decision aids compared to usual care interventions resulted in: a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18); b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); and c) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18). Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to bemade, or understanding that values affect the choice. C) Secondary outcomes Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable. The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. Authors' conclusions There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values. New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process. EMTREE DRUG INDEX TERMS antibiotic agent antithrombocytic agent hepatitis B vaccine influenza vaccine natural product prostate specific antigen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making health care screening treatment planning EMTREE MEDICAL INDEX TERMS anxiety birth control blood transfusion breast cancer cancer chemotherapy cancer genetics cancer prevention cancer screening cardiovascular disease childbirth Cinahl clinical assessment colon cancer confidence interval consultation cost effectiveness analysis depression diabetes mellitus elective surgery Embase embryo transfer emotional stress exercise test genetic screening health care system health practitioner health status hormonal therapy human immunotherapy lung transplantation Medline menopause osteoporosis outcome assessment patient compliance patient referral post hoc analysis prenatal screening priority journal PsycINFO quality of life randomized controlled trial (topic) review risk benefit analysis satisfaction schizophrenia systematic review thorax pain upper respiratory tract infection EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Drug Literature Index (37) CLINICAL TRIAL NUMBERS ISRCTN (ISRCTN14570598) ClinicalTrials.gov (NCT00148226) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160626769 MEDLINE PMID 24470076 (http://www.ncbi.nlm.nih.gov/pubmed/24470076) PUI L611821425 DOI 10.1002/14651858.CD001431.pub4 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD001431.pub4 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 194 TITLE Development of a personalized decision aid for breast cancer risk reduction and management. AUTHOR NAMES Ozanne E.M. Howe R. Omer Z. Esserman L.J. AUTHOR ADDRESSES (Ozanne E.M., elissa.m.ozanne@dartmouth.edu) Department of Surgery, Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA. (Howe R.; Omer Z.; Esserman L.J.) CORRESPONDENCE ADDRESS E.M. Ozanne, Email: elissa.m.ozanne@dartmouth.edu SOURCE BMC medical informatics and decision making (2014) 14 (4). Date of Publication: 2014 ISSN 1472-6947 (electronic) ABSTRACT Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians. Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium). Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting. BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention, therapy) decision making decision support system EMTREE MEDICAL INDEX TERMS adult aged article devices disease management female human information processing Internet male middle aged patient care risk assessment risk reduction standard utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 24422989 (http://www.ncbi.nlm.nih.gov/pubmed/24422989) PUI L373974902 DOI 10.1186/1472-6947-14-4 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6947-14-4 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 195 TITLE Enablers and barriers to using patient decision aids in early stage breast cancer consultations: a qualitative study of surgeons' views AUTHOR NAMES O'Brien M.A. Charles C. Lovrics P. Wright F.C. Whelan T. Simunovic M. Kennedy E. Grunfeld E. AUTHOR ADDRESSES (O'Brien M.A.) Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1 V7, Canada. maryann.obrien@utoronto.ca (O'Brien M.A.) Knowledge Translation Research Network, Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada. maryann.obrien@utoronto.ca (Charles C.) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. charlesc@mcmaster.ca (Lovrics P.) St. Joseph's Healthcare, Hamilton, ON, Canada. lovricsp@mcmaster.ca (Wright F.C.) Odette Cancer Centre, Toronto, ON, Canada. Frances.Wright@sunnybrook.ca (Whelan T., Tim.Whelan@jcc.hhsc.ca.Juravinski) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. (Whelan T., Tim.Whelan@jcc.hhsc.ca.Juravinski) Juravinski Cancer Centre, Hamilton, ON, Canada. (Simunovic M., Marko.Simunovic@jcc.hhsc.ca.Juravinski) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. (Simunovic M., Marko.Simunovic@jcc.hhsc.ca.Juravinski) Juravinski Cancer Centre, Hamilton, ON, Canada. (Kennedy E.) Mount Sinai Hospital, University Health Network, Toronto, ON, Canada. EKennedy@mtsinai.on.ca (Grunfeld E., eva.grunfeld@utoronto.ca.Knowledge) Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1 V7, Canada. (Grunfeld E., eva.grunfeld@utoronto.ca.Knowledge) Knowledge Translation Research Network, Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada. SOURCE Implementation science : IS (2014) 9 (174). Date of Publication: 2014 ISSN 1748-5908 (electronic) ABSTRACT BACKGROUND: For early stage breast cancer, randomized controlled trials (RCTs) have shown that patient decision aids (PtDAs), when used by surgeons, result in increased patient knowledge about options and different patient treatment choices as compared to standard care. Yet, recent data suggests that PtDAs are used by less than 25% of Canadian cancer physicians. We conducted a study to explore breast cancer surgeons' views on enablers and barriers to the use of PtDAs in their practice.METHODS: Purposeful sampling was used to select breast cancer surgeons in three Ontario health regions to participate in semi-structured interviews. Inductive coding and the constant comparative method were used to identify the main themes.RESULTS: Twenty-two surgeons (79%) agreed to participate (median age, 50 years; 9 (40%) female). Surgeons practiced in academic (n = 7, 32%) or community (n = 15, 68%) hospitals. Fourteen surgeons were aware of PtDAs, nine had used a PtDA with patients as part of an RCT, and six had developed their own informal PtDA for use in their practice. Enablers of informal PtDA use included surgeon exposure during training and surgeon perceived need for a systematic approach when communicating risks and benefits of surgical treatments with patients. Barriers to formal PtDA use included high surgeon confidence in their verbal communication skills, surgeon belief that patients understood conveyed information, and difficulties embedding such tools in practice routines.CONCLUSIONS: Surgeons in this study valued systematic communication with patients. Several surgeons changed their practice to include formal or informal PtDAs provided they perceived there was a clear benefit to themselves or to patients. However, high surgeon confidence in their personal communications skills coupled with beliefs that patients understand conveyed information may be key barriers to PtDA uptake once surgeons have established communication routines. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general surgery health personnel attitude utilization EMTREE MEDICAL INDEX TERMS awareness breast tumor (surgery) Canada clinical competence decision support system female human interpersonal communication male mass communication middle aged patient referral standards LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25433370 (http://www.ncbi.nlm.nih.gov/pubmed/25433370) PUI L609410560 DOI 10.1186/s13012-014-0174-0 FULL TEXT LINK http://dx.doi.org/10.1186/s13012-014-0174-0 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 196 TITLE Risk prediction tools in surgical oncology AUTHOR NAMES Kinnier C.V. Asare E.A. Mohanty S. Paruch J.L. Rajaram R. Bilimoria K.Y. AUTHOR ADDRESSES (Kinnier C.V.; Bilimoria K.Y., k-bilimoria@northwestern.edu) Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, United States. (Kinnier C.V.) Department of Surgery, Massachusetts General Hospital, Boston, United States. (Asare E.A.; Mohanty S.; Paruch J.L.; Rajaram R.) Division of Research and Optimal Patient Care, American College of Surg., Chicago, United States. (Asare E.A.) Department of Surgery, Medical College of Wisconsin, Milwaukee, United States. (Mohanty S.) Department of Surgery, Henry Ford Hospital, Detroit, United States. (Paruch J.L.) Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, United States. (Rajaram R.) Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, United States. (Rajaram R.) Department of Surgery, Northwestern Memorial Hospital, Chicago, United States. (Bilimoria K.Y., k-bilimoria@northwestern.edu) Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, United States. CORRESPONDENCE ADDRESS K.Y. Bilimoria, Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, United States. SOURCE Journal of Surgical Oncology (2014) 110:5 (500-508). Date of Publication: 1 Oct 2014 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Healthcare has increasingly focused on patient engagement and shared decision-making. Decision aids can promote engagement and shared decision making by providing patients and their providers with care options and outcomes. This article discusses decision aids for surgical oncology patients. Topics include: short-term risk prediction following surgery, long-term risk prediction of survival and recurrence, the combination of short- and long-term risk prediction to help guide treatment choice, and decision aid usability, transparency, and accessibility. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer surgery prediction risk assessment surgical risk EMTREE MEDICAL INDEX TERMS algorithm breast cancer calculation cancer patient cancer recurrence cancer survival cancer therapy clinical trial (topic) colon cancer conference paper decision support system health care access health literacy human patient care priority journal EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015253132 MEDLINE PMID 24975865 (http://www.ncbi.nlm.nih.gov/pubmed/24975865) PUI L605517462 DOI 10.1002/jso.23714 FULL TEXT LINK http://dx.doi.org/10.1002/jso.23714 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 197 TITLE BRECONDA: Development and acceptability of an interactive decisional support tool for women considering breast reconstruction AUTHOR NAMES Sherman K.A. Harcourt D.M. Lam T.C. Shaw L.-K. Boyages J. AUTHOR ADDRESSES (Sherman K.A., kerry.sherman@mq.edu.au; Shaw L.-K.) Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia. (Sherman K.A., kerry.sherman@mq.edu.au; Lam T.C.; Boyages J.) Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. (Harcourt D.M.) Centre for Appearance Research, University of the West of England, Bristol, United Kingdom. (Boyages J.) Macquarie University Cancer Institute, Sydney, Australia. CORRESPONDENCE ADDRESS K.A. Sherman, Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia. Email: kerry.sherman@mq.edu.au SOURCE Psycho-Oncology (2014) 23:7 (835-838). Date of Publication: July 2014 ISSN 1099-1611 (electronic) 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision support system EMTREE MEDICAL INDEX TERMS adult cancer adjuvant therapy cancer chemotherapy cancer risk cancer staging cancer surgery family history female hereditary tumor (surgery) human information processing intraductal carcinoma (surgery) letter mastectomy patient decision making patient satisfaction pilot study randomized controlled trial (topic) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014452277 MEDLINE PMID 24991748 (http://www.ncbi.nlm.nih.gov/pubmed/24991748) PUI L53006567 DOI 10.1002/pon.3498 FULL TEXT LINK http://dx.doi.org/10.1002/pon.3498 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 198 TITLE An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. AUTHOR NAMES Jordan S.W. Khavanin N. Fine N.A. Kim J.Y. AUTHOR ADDRESSES (Jordan S.W.) Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine. (Khavanin N.; Fine N.A.; Kim J.Y.) CORRESPONDENCE ADDRESS S.W. Jordan, SOURCE Plastic and reconstructive surgery (2014) 134:2 (178-188). Date of Publication: Aug 2014 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix use has gained widespread acceptance--despite higher material costs--because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy. The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes. One hundred ninety-three breasts underwent reconstruction before and 179 underwent reconstruction after implementation of the algorithm. Overall complication rates did not differ between the cohorts (22.8 percent versus 20.7 percent; p=0.138). After adjusting for potential confounders, the algorithm did not significantly affect the incidence of infection, seroma, flap necrosis, explantation, or overall complications (all p>0.05). Aesthetic scores were not affected (2.75 of 4 versus 3.03 of 4; p=0.138). Acellular dermal matrix use decreased from 84 percent to 36 percent, resulting in a materials cost savings of $270,000 over the study period. This algorithm obviated placement of acellular dermal matrix in an estimated 48 percent of immediate tissue-expander reconstructions. Patients treated after adoption of this algorithm experienced similar complication rates and aesthetic outcomes as those who underwent reconstruction before. The authors' preliminary outcomes demonstrate that evidence-based measures can be taken to selectively use acellular dermal matrix without a concomitant worsening of patient outcomes. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix algorithm breast reconstruction decision support system EMTREE MEDICAL INDEX TERMS adult article breast tumor (surgery) drug contraindication economics esthetics evaluation study female human incidence mastectomy methodology middle aged postoperative complication (epidemiology, etiology) retrospective study statistical model United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 25068318 (http://www.ncbi.nlm.nih.gov/pubmed/25068318) PUI L373972873 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 199 TITLE Decision analysis and cost-effectiveness analysis for comparative effectiveness research-a primer AUTHOR NAMES Sher D.J. Punglia R.S. AUTHOR ADDRESSES (Sher D.J., david_sher@rush.edu) Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States. (Punglia R.S.) Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States. CORRESPONDENCE ADDRESS D.J. Sher, Rush University Medical Center, Department of Radiation Oncology, Chicago, IL, United States. Email: david_sher@rush.edu SOURCE Seminars in Radiation Oncology (2014) 24:1 (14-24). Date of Publication: January 2014 ISSN 1053-4296 1532-9461 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Although the analysis of real-world data is the foundation of comparative effectiveness analysis, not all clinical questions are easily approached with patient-derived information. Decision analysis is a set of modeling and analytic tools that simulate treatment and disease processes, including the incorporation of patient preferences, thus generating optimal treatment strategies for varying patient, disease, and treatment conditions. Although decision analysis is informed by evidence-derived outcomes, its ability to test treatment strategies under different conditions that are realistic but not necessarily reported in the literature makes it a useful and complementary technique to more standard data analysis. Similarly, cost-effectiveness analysis is a discipline in which the relative costs and benefits of treatment alternatives are rigorously compared. With the well-recognized increase in highly technical, costly radiation therapy technologies, the cost-effectiveness of these different treatments would come under progressively more scrutiny. In this review, we discuss the theoretical and practical aspects of decision analysis and cost-effectiveness analysis, providing examples that highlight their methodology and utility. © 2014 Elsevier Inc. EMTREE DRUG INDEX TERMS analgesic agent (drug therapy) antineoplastic agent (drug therapy) prostate specific antigen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) comparative effectiveness cost effectiveness analysis health care cost medical decision making EMTREE MEDICAL INDEX TERMS article bone metastasis (disease management, drug therapy, radiotherapy) bone pain (disease management, drug therapy, radiotherapy) breast cancer (disease management, radiotherapy, surgery) cancer chemotherapy cancer pain (drug therapy) cancer palliative therapy cancer radiotherapy cancer recurrence cancer screening cohort analysis cost benefit analysis cost minimization analysis cost utility analysis data analysis decision tree diagnostic error distant metastasis early diagnosis evidence based medicine human incremental cost effectiveness ratio intensity modulated radiation therapy life expectancy mastectomy mathematical model medicare methodology Monte Carlo method outcome assessment partial mastectomy patient decision making patient preference priority journal probability prostate cancer (diagnosis, disease management, radiotherapy) proton therapy quality adjusted life year quality of life radiation dose fractionation radiation hazard randomized controlled trial (topic) reimbursement stereotactic body radiation therapy treatment outcome willingness to pay EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013763076 MEDLINE PMID 24314338 (http://www.ncbi.nlm.nih.gov/pubmed/24314338) PUI L370386883 DOI 10.1016/j.semradonc.2013.08.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.semradonc.2013.08.002 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 200 TITLE A 'green button' for using aggregate patient data at the point of care AUTHOR NAMES Longhurst C.A. Harrington R.A. Shah N.H. AUTHOR ADDRESSES (Longhurst C.A., clonghurst@stanford.edu; Harrington R.A.) Stanford University, School of Medicine, Stanford, CA, United States. (Longhurst C.A., clonghurst@stanford.edu) Stanford Children's Health, Palo Alto, United States. (Shah N.H.) Center for Biomedical Informatics Research, Stanford University, School of Medicine, United States. SOURCE Health Affairs (2014) 33:7 (1229-1235). Date of Publication: 2014 ISSN 1544-5208 (electronic) 0278-2715 BOOK PUBLISHER Project HOPE, jtucker@healthaffairs.org ABSTRACT Randomized controlled trials have traditionally been the gold standard against which all other sources of clinical evidence are measured. However, the cost of conducting these trials can be prohibitive. In addition, evidence from the trials frequently rests on narrow patientinclusion criteria and thus may not generalize well to real clinical situations. Given the increasing availability of comprehensive clinical data in electronic health records (EHRs), some health system leaders are now advocating for a shift away from traditional trials and toward large-scale retrospective studies, which can use practice-based evidence that is generated as a by-product of clinical processes. Other thought leaders in clinical research suggest that EHRs should be used to lower the cost of trials by integrating point-of-care randomization and data capture into clinical processes.We believe that a successful learning health care system will require both approaches, and we suggest a model that resolves this escalating tension: a "green button" function within EHRs to help clinicians leverage aggregate patient data for decision making at the point of care. Giving clinicians such a tool would support patient care decisions in the absence of gold-standard evidence and would help prioritize clinical questions for which EHR-enabled randomization should be carried out. The privacy rule in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may require revision to support this novel use of patient data. © 2014 by Project HOPE - The People-to-People Health Foundation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electronic medical record evidence based medicine health care system learning health care system EMTREE MEDICAL INDEX TERMS alarm monitor article breast cancer (diagnosis) cancer recurrence (diagnosis) clinical practice clinical research comparative effectiveness decision making device safety gold standard health care policy health insurance hospital information system hospitalized child human information technology learning medical device medical ethics outcomes research patient information peripheral occlusive artery disease (diagnosis) pneumonia (diagnosis) point of care testing privacy randomization randomized controlled trial (topic) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Internal Medicine (6) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014543834 MEDLINE PMID 25006150 (http://www.ncbi.nlm.nih.gov/pubmed/25006150) PUI L373761659 DOI 10.1377/hlthaff.2014.0099 FULL TEXT LINK http://dx.doi.org/10.1377/hlthaff.2014.0099 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 201 TITLE Knowledge, attitudes and referral patterns of lynch syndrome: A survey of clinicians in Australia AUTHOR NAMES Tan Y.Y. Spurdle A.B. Obermair A. AUTHOR ADDRESSES (Tan Y.Y., y.tan@uq.edu.au; Obermair A., obermair@powerup.com.au) School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia. (Tan Y.Y., y.tan@uq.edu.au; Obermair A., obermair@powerup.com.au) Molecular Cancer Epidemiology Laboratory, Genetics and Computational Biology Division, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia. (Tan Y.Y., y.tan@uq.edu.au; Spurdle A.B., amanda.spurdle@qimrberghofer.edu.au) Queensland Centre for Gynaecological Cancer Research, Royal Brisbane and Women's Hospital, Level 6 Ned Hanlon Building, Butterfield Street, Herston, QLD 4029, Australia. CORRESPONDENCE ADDRESS Y. Y. Tan, School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia. Email: y.tan@uq.edu.au SOURCE Journal of Personalized Medicine (2014) 4:2 (218-244). Date of Publication: 2014 ISSN 2075-4426 (electronic) BOOK PUBLISHER MDPI AG, Postfach, Basel, Switzerland. membranes@mdpi.com ABSTRACT This study assessed Australian clinicians' knowledge, attitudes and referral patterns of patients with suspected Lynch syndrome for genetic services. A total of 144 oncologists, surgeons, gynaecologists, general practitioners and gastroenterologists from the Australian Medical Association and Clinical Oncology Society responded to a web-based survey. Most respondents demonstrated suboptimal knowledge of Lynch syndrome. Male general practitioners who have been practicing for ≥10 years were less likely to offer genetic referral than specialists, and many clinicians did not recognize that immunohistochemistry testing is not a germline test. Half of all general practitioners did not actually refer patients in the past 12 months, and 30% of them did not feel that their role is to identify patients for genetic referral. The majority of clinicians considered everyone to be responsible for making the initial referral to genetic services, but a small preference was given to oncologists (15%) and general practitioners (13%). Patient information brochures, continuing genetic education programs and referral guidelines were favoured as support for practice. Targeted education interventions should be considered to improve referral. An online family history assessment tool with built-in decision support would be helpful in triaging high-risk individuals for pathology analysis and/or genetic assessment in general practice. © 2014 by the authors; licensee MDPI, Basel, Switzerland. EMTREE DRUG INDEX TERMS CA 125 antigen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hereditary nonpolyposis colorectal cancer knowledge patient referral physician attitude EMTREE MEDICAL INDEX TERMS adult article Australia clinical assessment tool colon resection colonoscopy colorectal cancer echomammography endometrium cancer family history female gastroenterologist gastroscopy general practitioner genetic counseling genetic service gynecologist human hysterectomy male mastectomy oncologist ovary cancer salpingooophorectomy stomach cancer surgeon thyroid cancer EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014339478 PUI L373098984 DOI 10.3390/jpm4020218 FULL TEXT LINK http://dx.doi.org/10.3390/jpm4020218 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 202 TITLE Circulating tumor cell data: Integration with imaging and serum tumor markers for metastatic breast cancer patient management AUTHOR NAMES Marsland T. Schuur E.R. AUTHOR ADDRESSES (Marsland T.) Integrated Community Oncology Network, Orange Park, FL, United States. (Schuur E.R., eric@vmwa.biz) VMWA LLC, 2493 Waverley Street, Palo Alto, CA 94301, United States. (Schuur E.R., eric@vmwa.biz) Jon Block Group, San Francisco, CA, United States. SOURCE Case Reports in Oncology (2014) 7:1 (175-181). Date of Publication: January-April 2014 ISSN 1662-6575 (electronic) BOOK PUBLISHER S. Karger AG ABSTRACT Management of metastatic breast cancer is critical to maximizing survival with good quality of life. Circulating tumor cell (CTC) levels in the peripheral blood hold promise for enabling improved patient care. We describe a case of a 47-year-old female with infiltrating ductal carcinoma who developed metastatic disease. Serum tumor markers were discordant with imaging studies at several time points. CTC levels were used to support decision making in light of the discordant data. The use of this tool enabled prompt changes in therapy with progressive disease and supported suspending therapy to enable recovery from treatment adverse effects when a significant response was detected by imaging and CTCs were absent from the peripheral circulation. The additional information provided by CTC enumeration helped clarify disease status and provided support for treatment decisions. © 2014 S. Karger AG, Basel. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tumor marker (endogenous compound) EMTREE DRUG INDEX TERMS bevacizumab (adverse drug reaction, drug combination, drug therapy) CA 27-29 antigen (endogenous compound) carcinoembryonic antigen (endogenous compound) doxorubicin (drug combination, drug therapy) estrogen receptor (endogenous compound) fulvestrant (drug combination) letrozole paclitaxel (drug combination, drug therapy) pamidronic acid progesterone receptor (endogenous compound) zoledronic acid (drug combination) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) circulating tumor cell metastatic breast cancer (drug therapy, drug therapy, radiotherapy, surgery) patient care EMTREE MEDICAL INDEX TERMS adult article bone metastasis (radiotherapy) cancer chemotherapy cancer radiotherapy cancer recurrence cancer staging case report Caucasian clinical decision making computer assisted emission tomography female femur tumor (radiotherapy) human human tissue liver metastasis (radiotherapy) low back pain middle aged neuropathy (side effect) partial mastectomy priority journal treatment refusal DRUG TRADE NAMES abraxane CAS REGISTRY NUMBERS bevacizumab (216974-75-3) doxorubicin (23214-92-8, 25316-40-9) fulvestrant (129453-61-8) letrozole (112809-51-5) paclitaxel (33069-62-4) pamidronic acid (40391-99-9, 57248-88-1) zoledronic acid (118072-93-8, 131654-46-1, 165800-06-6, 165800-07-7) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014333462 PUI L373080693 DOI 10.1159/000360983 FULL TEXT LINK http://dx.doi.org/10.1159/000360983 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 203 TITLE Racial and ethnic variation in partner perspectives about the breast cancer treatment decision-making experience AUTHOR NAMES Lillie S.E. Janz N.K. Friese C.R. Graff J.J. Schwartz K. Hamilton A.S. Gay B.B. Katz S.J. Hawley S.T. AUTHOR ADDRESSES (Lillie S.E.) Minneapolis Veterans Affairs Medical Center, Minnesota, United States. (Janz N.K.) Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, United States. (Friese C.R.) School of Nursing, University of Michigan, Ann Arbor, United States. (Graff J.J.) Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, United States. (Schwartz K.) Department of Family Medicine, Wayne State University, Detroit, MI, United States. (Hamilton A.S.) Department of Preventive Medicine, University of Southern California, Los Angeles, United States. (Gay B.B.) Department of Internal Medicine, University of Michigan, United States. (Katz S.J.; Hawley S.T., sarahawl@umich.edu) Department of Internal Medicine, University of Michigan, Ann Arbor, United States. SOURCE Oncology Nursing Forum (2014) 41:1 (13-20). Date of Publication: January 2014 ISSN 1538-0688 (electronic) 0190-535X ABSTRACT Purpose/Objectives: To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes. Design: A cross-sectional survey. Setting: Los Angeles, CA, and Detroit, MI. Sample: 517 partners of a population-based sample of patients with breast cancer four years post-treatment. Methods: A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes. Main Research Variables: Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement. Findings: Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p < 0.001). Factors significantly associated (p < 0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement. Conclusions: Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less accultur-ated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process. Implications for Nursing: Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support. © Oncology Nursing Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) decision making emotion patient participation sexuality EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adjuvant therapy African American American Indian attitude to health breast cancer cancer registry Caucasian comparative study cross-sectional study cultural factor ethnology family and caregivers female health care survey Hispanic human informed consent male mastectomy methodology multicenter study patient education psychological aspect questionnaire review United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24368235 (http://www.ncbi.nlm.nih.gov/pubmed/24368235) PUI L1372219970 DOI 10.1188/14.ONF.13-20 FULL TEXT LINK http://dx.doi.org/10.1188/14.ONF.13-20 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 204 TITLE Discussion: An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. AUTHOR NAMES Hanasono M.M. AUTHOR ADDRESSES (Hanasono M.M.) Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center. CORRESPONDENCE ADDRESS M.M. Hanasono, SOURCE Plastic and reconstructive surgery (2014) 134:2 (189-190). Date of Publication: Aug 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix algorithm breast reconstruction decision support system EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 25068319 (http://www.ncbi.nlm.nih.gov/pubmed/25068319) PUI L373972874 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 205 TITLE Important factors affecting adjuvant treatment decision in stage IA breast cancer patients in Turkey AUTHOR NAMES Oven Ustaalioglu B.B. Bilici A. Yilmaz B.E. Aliustaoglu M. Seker M. Vardar F. Gumus M. AUTHOR ADDRESSES (Oven Ustaalioglu B.B., basakoven@yahoo.com; Yilmaz B.E.; Aliustaoglu M.) Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Selimiye Mah, Sair Nesimi sok, Kardesler, 34668 Uskudar, Istanbul, Turkey. (Bilici A.) Department of Medical Oncology, Medipol University, Turkey. (Seker M.; Gumus M.) Department of Medical Oncology, Kartal Education and Research Hospital, Turkey. (Vardar F.) Department of Pathology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. CORRESPONDENCE ADDRESS B.B. Oven Ustaalioglu, Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Selimiye Mah, Sair Nesimi sok, Kardesler, 34668 Uskudar, Istanbul, Turkey. Email: basakoven@yahoo.com SOURCE Breast Care (2014) 9:2 (123-127). Date of Publication: May 2014 ISSN 1661-3805 (electronic) 1661-3791 BOOK PUBLISHER S. Karger AG ABSTRACT Introduction: In Turkey, the gene expression profile test is not standard, so adjuvant treatment is planned according to clinicopathological factors. Therefore, we retrospectively analyzed important parameters that affect the decision on adjuvant chemotherapy, and also factors related to survival in stage IA breast cancer patients in Turkey. Methods: We retrospectively evaluated 347 stage IA patients. The relationship between the clinicopathological parameters and adjuvant chemotherapy was analyzed. Results: The median age and follow-up time were 52 years (range: 25-86) and 22.6 months (range: 1-113), respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 87.9% and 98.7%, respectively, but the median DFS was not reached. Age, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, and the presence of triple-negative breast tumor (TNBC) were related to DFS, and lymphovascular invasion (LVI), perineural invasion (PNI), HER2 status, the presence of TNBC, and recurrence were related to OS (p < 0.05). Furthermore, age, menopausal status, multicentricity, grade, tumor size, necrosis, ER, the presence of TNBC, and HER2 were found to be related to adjuvant therapy decision (p < 0.05). All these parameters, in addition to LVI and PNI, were independent factors for chemotherapy by logistic regression analysis. Conclusions: In decisions about adjuvant therapy in stage IA breast cancer patients, clinicopathological factors should be kept in mind. © 2014 S. Karger GmbH, Freiburg. EMTREE DRUG INDEX TERMS epidermal growth factor receptor 2 (endogenous compound) estrogen receptor (endogenous compound) trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer adjuvant therapy cancer staging clinical decision making triple negative breast cancer (drug therapy, drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult aged article cancer radiotherapy cancer recurrence cancer surgery cancer survival disease free survival distant metastasis female follow up human lymph vessel metastasis major clinical study mastectomy medical record review menopause overall survival patient perineural invasion priority journal retrospective study tumor necrosis tumor volume Turkey (republic) very elderly CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014362304 PUI L373170456 DOI 10.1159/000360929 FULL TEXT LINK http://dx.doi.org/10.1159/000360929 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 206 TITLE Effect of PREDICT on chemotherapy/trastuzumab recommendations in HER2‑positive patients with early‑stage breast cancer AUTHOR NAMES Down S.K. Lucas O. Benson J.R. Wishart G.C. AUTHOR ADDRESSES (Down S.K., sue.down@jpaget.nhs.uk; Lucas O.; Benson J.R.) Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. (Wishart G.C.) Social Care and Education, Anglia Ruskin University, Cambridge, United Kingdom. CORRESPONDENCE ADDRESS S.K. Down, Department of Breast Surgery, James Paget University Hospital, Lowestoft Road, Gorleston, Great Yarmouth, Norfolk, United Kingdom. SOURCE Oncology Letters (2014) 8:6 (2757-2761). Date of Publication: 1 Dec 2014 ISSN 1792-1082 (electronic) 1792-1074 BOOK PUBLISHER Spandidos Publications, 10 Vriaxidos Street, Athens, Greece. ABSTRACT PREDICT is an online prognostication tool for early‑stage breast cancer, which incorporates human epidermal growth factor 2 (HER2) status and stratifies absolute treatment benefits for hormone therapy, chemotherapy and trastuzumab. The present study compared historical multidisciplinary team (MDT) decisions regarding adjuvant treatment with PREDICT estimates, to determine whether certain patients are being over‑ or undertreated, particularly when stratified by age and oestrogen‑receptor (ER) status. HER2‑positive early‑stage breast cancer cases over a five‑year period at the Cambridge Breast Unit (Addenbrooke's Hospital, Cambridge, UK) were retrospectively reviewed. Patients receiving neo‑adjuvant therapy were excluded. Adjuvant chemotherapy/trastuzumab recommendations based on PREDICT (< 3%, no benefit; 3‑5%, discuss treatment; and >5%, recommend treatment) were compared with actual MDT decisions. In total, 109 eligible patients were identified. The average age at diagnosis was 59.6 years, with 21 patients older than 70 years (19%). Four patients were predicted to gain an absolute benefit of >5% from chemotherapy/ trastuzumab, but were not offered treatment (all >70 years). Amongst the 19 patients aged >70 years predicted to benefit >3%, six were not offered treatment (32%). In the patients aged < 69 years, there was evidence of overtreatment with adjuvant chemotherapy/trastuzumab in 8 out of 12 cases with < 3% benefit using PREDICT. For all 20 patients with ER‑negative tumours, the MDT and PREDICT decisions correlated, whilst for ER‑positive cases, more than half (8 out of 14) were offered treatment despite a < 3% predicted benefit. PREDICT can aid decision‑making in HER2‑positive early‑stage breast cancer by identifying older patients at risk of undertreatment with chemotherapy/trastuzumab, and by reducing the overtreatment of patients with little predicted benefit, particularly in ER‑positive disease. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) epidermal growth factor receptor 2 (endogenous compound) trastuzumab (drug therapy) EMTREE DRUG INDEX TERMS estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy) online system PREDICT EMTREE MEDICAL INDEX TERMS adult aged article cancer prognosis cancer staging clinical decision making female human lymph node major clinical study mastectomy middle aged retrospective study CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014839555 PUI L600214484 DOI 10.3892/ol.2014.2589 FULL TEXT LINK http://dx.doi.org/10.3892/ol.2014.2589 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 207 TITLE Validity of adjuvant! Online program in older patients with breast cancer: A population-based study AUTHOR NAMES De Glas N.A. Van de Water W. Engelhardt E.G. Bastiaannet E. De Craen A.J.M. Kroep J.R. Putter H. Stiggelbout A.M. Weijl N.I. Van de Velde C.J.H. Portielje J.E.A. Liefers G.-J. AUTHOR ADDRESSES (De Glas N.A.; Van de Water W.; Bastiaannet E.; Van de Velde C.J.H.; Liefers G.-J., g.j.liefers@lumc.nl) Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands. (De Glas N.A.; Van de Water W.; Bastiaannet E.; De Craen A.J.M.) Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands. (Engelhardt E.G.; Stiggelbout A.M.) Department of Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands. (Kroep J.R.) Department of Medical Oncology, Leiden University Medical Centre, Leiden, Netherlands. (Putter H.) Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands. (Weijl N.I.) Department of Medical Oncology, Bronovo Hospital The Hague, The Hague, Netherlands. (Portielje J.E.A.) Department of Medical Oncology, Haga Hospital The Hague, Leyweg, The Hague, Netherlands. CORRESPONDENCE ADDRESS G.-J. Liefers, Leiden University Medical Centre, Department of Surgery, Postzone K6-R, PO Box 9600, 2300 RC Leiden, Netherlands. Email: g.j.liefers@lumc.nl SOURCE The Lancet Oncology (2014) 15:7 (722-729). Date of Publication: June 2014 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com ABSTRACT Background: Adjuvant! Online is a prediction tool that can be used to aid clinical decision making in patients with breast cancer. It was developed in a patient population aged 69 years or younger, and subsequent validation studies included small numbers of older patients. Since older patients with breast cancer differ from younger patients in many aspects, the aim of this study was to investigate the validity of Adjuvant! Online in a large cohort of unselected older patients. Methods: We included patients from the population-based FOCUS cohort, which included all consecutive patients aged 65 years or older who were diagnosed with invasive or in-situ breast cancer between Jan 1, 1997, and Dec 31, 2004, in the southwestern part of the Netherlands. We included all patients who fulfilled the criteria as stated by Adjuvant! Online: patients with unilateral, unicentric, invasive adenocarcinoma; no evidence of metastatic or residual disease; no evidence of T4 features; and no evidence of inflammatory breast cancer. We entered data from all patients with the "average for age" comorbidity status (model 1) and with an individualised comorbidity status (model 2). Findings: We included 2012 patients. Median age of patients in the cohort was 74·0 years (IQR 69·0-79·0). 904 (45%) of 2012 patients died during follow-up, whereas 326 (16%) patients had recurrence. Median follow-up for overall survival was 9·0 years (IQR 7·4-10·7), and 6·6 years (4·4-6·6) for patients without recurrence. Using model 1, Adjuvant! Online overestimated 10-year overall survival by 9·8% ([95% CI 5·9-13·7], p<0·0001) and 10-year cumulative recurrence survival by 8·7% ([6·7-10·7], p<0·0001). By contrast, when using model 2, Adjuvant! Online underestimated the 10-year overall survival by -17·1% ([95% CI -21·0 to -13·2], p<0·0001). However, when using model 2, Adjuvant! Online predicted cumulative recurrence accurately in all patients (-0·7% [95% CI -2·7-1·3], p=0·48). Interpretation: Adjuvant! Online does not accurately predict overall survival and recurrence in older patients with early breast cancer. Funding: Dutch Cancer Foundation. © 2014 Elsevier Ltd. EMTREE DRUG INDEX TERMS estrogen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer recurrence information service overall survival predictive value EMTREE MEDICAL INDEX TERMS age aged article cancer surgery cancer survival clinical decision making comorbidity female follow up human instrument validation major clinical study mastectomy measurement accuracy Netherlands population research priority journal receiver operating characteristic sensitivity and specificity software tumor volume very elderly DEVICE TRADE NAMES Adjuvant Online EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014367457 MEDLINE PMID 24836274 (http://www.ncbi.nlm.nih.gov/pubmed/24836274) PUI L53134034 DOI 10.1016/S1470-2045(14)70200-1 FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(14)70200-1 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 208 TITLE Indication of post-mastectomy radiation associated with risk of local recurrence in breast cancer patients with 1-3 lymph node metastasis AUTHOR NAMES Saruwatari A. Ishida M. Koi Y. Akiyoshi S. Igawa A. Oikawa M. Koga C. Nishimura S. Nakamura Y. Ohno S. AUTHOR ADDRESSES (Saruwatari A.; Ishida M.; Koi Y.; Akiyoshi S.; Igawa A.; Oikawa M.; Koga C.; Nishimura S.; Nakamura Y.; Ohno S.) Natinal Kyushu Cancer Center, Fukuoka, Japan. CORRESPONDENCE ADDRESS A. Saruwatari, Natinal Kyushu Cancer Center, Fukuoka, Japan. SOURCE Cancer Research (2013) 73:24 SUPPL. 1. Date of Publication: 15 Dec 2013 CONFERENCE NAME 36th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2013-12-10 to 2013-12-14 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Objective: Post-mastectomy radiotherapy (PMRT) is strongly recommended for breast cancer patients with 1 to 3 axillary lymph node metastasis (N1-3) in NCCN guidelines Version 3.2013 (category 1), whereas the indication of that treatment should be considered individually according to the risk of local recurrence (St Gallen Consensus Meeting 2013). In order to support decision making of PMRT, we evaluated the risk factors of local recurrence after mastectomy. Patients and methods: We reviewed retrospectively 2422 cases with Stage I - III primary breast cancer receiving surgery at National Kyushu Cancer Center between 2000 and 2009. Seven hundred seventy six of them underwent mastectomy, and 547 of them received no PMRT. We analyzed the risk of local recurrence in relation to clinicopathologial factors, the status of hormone receptor and HER2, especially in cases with N1-3. Results: Among 547 cases with no PMRT, there were 364 cases with no LN metastasis (N0), 146 N1-3, and 37 N≥4, and 5-year local disease free survival (DFS) rates were 97.0%, 91.2%, and 73.4%, respectively. In N1-3 (146) cases who underwent no post-operative regional radiotherapies, the 5-year DFS in extent of lymph vessel infiltration (ly) were: ly0 was 97.9% (50) and ly1-3 was 87.9% (92) (ly unknown were 4). In the ly0 cases, the 5-year local DFSs were 100% in grade 2 and 85.7% in grade 3; 100% in ER positive and 90.0% in ER negative; 90.9% in HER2 positive and 100% in HER2 negative. Those in the cases of ly1-3 were 94.5% and 73.4%, 88.7% and 76.6%, and 91.0% and 64.3%, respectively. Conclusion: In patients with N1-3 breast cancer, the risk of local recurrence after mastectomy was significantly related to grade, extent of lymph vessel infiltration, ER and HER2. PMRT could be omitted in case with ly0,additionaly with grade 1-2, ER positive and HER2 negative. The remaining cases have the risk of local recurrence over 10%, if they don't receive PMRT, in which the indication of PMRT should be considered. EMTREE DRUG INDEX TERMS hormone receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human lymph node metastasis mastectomy radiation risk EMTREE MEDICAL INDEX TERMS axillary lymph node cancer center consensus decision making disease free survival lymph vessel metastasis patient radiotherapy risk factor surgery survival rate LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71471970 DOI 10.1158/0008-5472.SABCS13-P5-14-18 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS13-P5-14-18 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 209 TITLE Partnership and consent in MS treatment choice AUTHOR NAMES Palace J. AUTHOR ADDRESSES (Palace J., jacqueline.palace@clneuro.ox.ac.uk) Clinical Neurology, Oxford University Hospitals Trust, Oxford, United Kingdom. CORRESPONDENCE ADDRESS J. Palace, Clinical Neurology, Oxford University Hospitals Trust, Oxford, United Kingdom. Email: jacqueline.palace@clneuro.ox.ac.uk SOURCE Journal of the Neurological Sciences (2013) 335:1-2 (5-8). Date of Publication: 15 Dec 2013 ISSN 0022-510X 1878-5883 (electronic) BOOK PUBLISHER Elsevier, P.O. Box 211, Amsterdam, Netherlands. ABSTRACT It is not only good medical practice to ensure patients are fully involved in their treatment decisions, but it also improves subsequent compliance, and may even be cost effective. However, choosing treatments in MS is becoming increasingly complex, which means that ensuring patients understand all the issues is a challenge and time consuming. Preference sensitive care (which applies to current MS immunomodulatory treatments) is particularly vulnerable to the individual doctor's opinion and there is an onus on the physician to ensure the decision made incorporates the patient's individual values. National patient decision making tools are an appropriate solution to this dilemma and may, in the future, be a legal requirement in consent to treatment. © 2013 Elsevier B.V. All rights reserved. EMTREE DRUG INDEX TERMS beta interferon (drug therapy) glatiramer (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) doctor patient relation informed consent multiple sclerosis (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS article breast cancer decision support system drug industry family planning health literacy human immunomodulation jurisprudence mastectomy medical information medical practice partial mastectomy patient compliance patient decision making patient information patient participation patient preference practice guideline priority journal quality of life tonsillectomy CAS REGISTRY NUMBERS glatiramer (147245-92-9, 28704-27-0) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013737240 MEDLINE PMID 24090756 (http://www.ncbi.nlm.nih.gov/pubmed/24090756) PUI L52796386 DOI 10.1016/j.jns.2013.09.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.jns.2013.09.001 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 210 TITLE Clinical utility of a radiosensitivity molecular signature: Identification of breast cancer patients that benefit from RT boost dose AUTHOR NAMES Torres-Roca J.F. Servant N. Bollet M.A. Eschrich S.A. AUTHOR ADDRESSES (Torres-Roca J.F.; Servant N.; Bollet M.A.; Eschrich S.A.) Moffitt Cancer Center, Tampa, FL; Institut Curie, Paris, France SOURCE Cancer Research (2013) 73:24 SUPPL. 1. Date of Publication: 15 Dec 2013 CONFERENCE NAME 36th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2013-12-10 to 2013-12-14 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Objective: In previous studies we developed a radiosensitivity molecular signature (RSI) that has been independently validated in multiple disease sites (n = 652) including breast cancer 1-3. Here, we test whether RSI can be utilized to identify sub-populations in breast cancer that benefit from RT dose intensification (boost). Methods: RSI was tested in two published breast cancer datasets (n = 342) 4. Patients were selected if they had experienced a local recurrence within the first 10 years after primary treatment or were free of local recurrence for a minimum of 10 years after treatment. Primary treatment was initial breast-conserving surgery plus whole breast RT with/without a boost (no boost, n = 94, low boost < = 66 Gy, n = 148, high boost >66 Gy, n = 100). Patients were treated between January 1984 and November 2002. RSI was generated as previously described 1-3. Time to local recurrence was used as the endpoint for the study. Results: Increased RT dose (>66 Gy vs. < = 66 Gy) resulted in a slight decrease in local recurrence risk that did not reach statistical significance (p = 0.11). As hypothesized, RSI-high patients (more radioresistant) were sensitive to increased RT dose (high RT-boost) which resulted in a decrease in local recurrence (HR = 0.3418, CI 0.1195-0.9777, p = 0.036). In contrast, RSI-low and intermediate patients had similar local recurrence risk independent of RT dose (RSI-low HR = 0.7687, CI 0.3404-1.736, p = 0.53, RSI-intermediate, HR = 0.9115, CI 0.5125-1.621, p = 0.75). Importantly, there were no statistical differences in the distribution of known prognostic variables between RSI-determined sub-populations (RSI-low, intermediate, high) including age, T-stage, margin status, nodal status, adjuvant chemotherapy, hormonal therapy, grade and molecular subtype. Conclusions: RSI identifies a sub-population of breast cancer patients that benefit from increased RT-dose. RSI may be utilized to support RT-based decisions (high boost vs. low boost vs. no boost) in breast cancer. 1. Eschrich S, Fulp WJ, Pawitan Y, et al: Validation of a Radiosensitivity Molecular Signature in Breast Cancer. Clin Cancer Res, 2012 2. Eschrich S, Zhang H, Zhao H, et al: Systems biology modeling of the radiation sensitivity network: a biomarker discovery platform. Int J Radiat Oncol Biol Phys 75:497-505, 2009 3. Eschrich SA, Pramana J, Zhang H, et al: A gene expression model of intrinsic tumor radiosensitivity: prediction of response and prognosis after chemoradiation. Int J Radiat Oncol Biol Phys 75:489-96, 2009 4. Servant N, Bollet MA, Halfwerk H, et al: Search for a gene expression signature of breast cancer local recurrence in young women. Clin Cancer Res 18:1704-15, 2012. EMTREE DRUG INDEX TERMS biological marker salicylate sodium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human radiosensitivity EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy breast chemoradiotherapy dental floss drug dose intensification female gene expression hormonal therapy implantable cardioverter defibrillator model neoplasm partial mastectomy patient population prediction prognosis recurrence risk statistical significance systems biology X ray bone densitometer LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71471726 DOI 10.1158/0008-5472.SABCS13-P2-11-11 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS13-P2-11-11 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 211 TITLE Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands AUTHOR NAMES Garvelink M.M. Ter Kuile M.M. Fischer M.J. Louwé L.A. Hilders C.G.J.M. Kroep J.R. Stiggelbout A.M. AUTHOR ADDRESSES (Garvelink M.M., m.m.garvelink@lumc.nl; Ter Kuile M.M.; Louwé L.A.) Department of Gynecology (VRSP), Leiden University Medical Center (LUMC), P/O Box 9600, 2300 RC Leiden, Netherlands. (Fischer M.J.; Kroep J.R.) Department of Clinical Oncology, LUMC, Leiden, Netherlands. (Hilders C.G.J.M.) Department of Gynecology, Reinier de Graaf Groep, Delft, Netherlands. (Stiggelbout A.M.) Department of Medical Decision Making, LUMC, Leiden, Netherlands. CORRESPONDENCE ADDRESS M.M. Garvelink, Department of Gynecology (VRSP), Leiden University Medical Center (LUMC), P/O Box 9600, 2300 RC Leiden, Netherlands. Email: m.m.garvelink@lumc.nl SOURCE Journal of Psychosomatic Obstetrics and Gynecology (2013) 34:4 (170-178). Date of Publication: December 2013 ISSN 0167-482X 1743-8942 (electronic) BOOK PUBLISHER Informa Healthcare, 69-77 Paul Street, London, United Kingdom. ABSTRACT Objectives: To improve information provision about fertility preservation for breast cancer patients in the Netherlands, a web-based Decision Aid (DA) with additional values clarification exercise was developed according to the International Patient Decision Aid Standards criteria. This study reports on development of the DA. Methods: Development consisted of four stages: (I) development of a draft DA, (II) acceptability of the draft DA to patients, (III) understanding (knowledge) in healthy populations, (IV) acceptability of the revised DA among patients and physicians. The study population consisted of 185 participants: 20 patients, 17 physicians and 148 healthy volunteers. Results: The draft DA was considered to be relevant and understandable by patients, physicians and healthy volunteers. The values clarification exercise needed adaptation in explanation and navigation, which was done after stage II. Knowledge scores improved by 18% for lower educated women (from 4.1 (41%) to 5.9 (59%) correct answers), and by 34% for higher educated women after viewing the website (from 3.9 (39%) to 7.3 (73%) correct answers). Design of the DA was evaluated to be clear, but not always very appealing. Conclusions: The DA was regarded as a relevant source of information that seemed coherent and understandable. © 2013 Informa UK Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision aid decision support system reproductive procedure EMTREE MEDICAL INDEX TERMS adaptation adult article clinical article female human knowledge Netherlands patient counseling patient decision making physician EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013712195 MEDLINE PMID 24188788 (http://www.ncbi.nlm.nih.gov/pubmed/24188788) PUI L370244306 DOI 10.3109/0167482X.2013.851663 FULL TEXT LINK http://dx.doi.org/10.3109/0167482X.2013.851663 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 212 TITLE Overdiagnosis and overtreatment of breast cancer: How can we promote informed patient choice? AUTHOR NAMES Ozanne E.M. AUTHOR ADDRESSES (Ozanne E.M., elissa.m.ozanne@dartmouth.edu) Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, United States. CORRESPONDENCE ADDRESS E.M. Ozanne, Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, United States. Email: elissa.m.ozanne@dartmouth.edu SOURCE Current Breast Cancer Reports (2013) 5:4 (263-265). Date of Publication: 2013 ISSN 1943-4588 1943-4596 (electronic) BOOK PUBLISHER Current Medicine Group LLC, 400 Market St,, Ste 700 Philadelphia, United States. ABSTRACT Stemming from closer examination of breast cancer incidence treads, there has been growing concern about the issues of overdiagnosis and overtreatment of breast cancer. As incidence trends showing a limited decline in later stage cancers shed doubt on the extent of benefit screening mammography holds, women need to be informed accordingly. However, it is apparent that women often do not fully understand the risks and benefits they face when undergoing screening mammography. Further, treatment decisions for women diagnosed with breast cancer are equally, if not more challenging, and studies suggest women are ill-informed here too. As the science improves and allows us to better differentiate bad acting cancers from those with no or limited risk, improved communication tools such as decision aids and shared decision making will be imperative as a means to promote informed patient choice. © 2013 Springer Science+Business Media New York. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) diagnostic error informed consent overdiagnosis overtreatment therapeutic error EMTREE MEDICAL INDEX TERMS article cancer diagnosis cancer patient cancer screening cancer therapy early diagnosis human intraductal carcinoma mammography medical decision making patient decision making patient information patient preference systematic review (topic) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014023763 PUI L52835090 DOI 10.1007/s12609-013-0128-6 FULL TEXT LINK http://dx.doi.org/10.1007/s12609-013-0128-6 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 213 TITLE Managing brain metastases patientswith and without radiotherapy: Initial lessons from a team-based consult service through a multidisciplinary integrated palliative oncology clinic AUTHOR NAMES Jung H. Sinnarajah A. Enns B. Voroney J.-P. Murray A. Pelletier G. Wu J.S.-Y. AUTHOR ADDRESSES (Jung H.) Department of Nursing, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, Canada. (Sinnarajah A.; Murray A.) Palliative and End of Life Care, Calgary Zone, Alberta Health Services, Calgary, Canada. (Sinnarajah A.; Voroney J.-P.; Murray A.; Pelletier G.; Wu J.S.-Y., Jackson.Wu@albertahealthservices.ca) Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Canada. (Enns B.) Spiritual Care and Patient Family Support Team, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, Canada. (Voroney J.-P.; Wu J.S.-Y., Jackson.Wu@albertahealthservices.ca) Division of Radiation Oncology, Tom Baker Cancer Centre, 1331-29th St NW, Calgary T2N 4N2, Canada. (Pelletier G.) Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, Canada. CORRESPONDENCE ADDRESS J.S.-Y. Wu, Division of Radiation Oncology, Tom Baker Cancer Centre, 1331-29th St NW, Calgary T2N 4N2, Canada. Email: Jackson.Wu@albertahealthservices.ca SOURCE Supportive Care in Cancer (2013) 21:12 (3379-3386). Date of Publication: December 2013 ISSN 0941-4355 1433-7339 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Purpose: A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development. Methods: Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric. Results: The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients. Conclusions: By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates patient-centered decision making and transition to end-of-life care. © 2013 Springer-Verlag Berlin Heidelberg. EMTREE DRUG INDEX TERMS dexamethasone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain metastasis (radiotherapy, surgery) cancer palliative therapy cancer radiotherapy EMTREE MEDICAL INDEX TERMS adult aged article breast cancer cancer center cancer prognosis deterioration human Karnofsky Performance Status major clinical study neurosurgery non small cell lung cancer overall survival patient decision making patient preference priority journal quality control terminal care treatment refusal very elderly CAS REGISTRY NUMBERS dexamethasone (50-02-2) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013764290 MEDLINE PMID 23934224 (http://www.ncbi.nlm.nih.gov/pubmed/23934224) PUI L52724978 DOI 10.1007/s00520-013-1917-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00520-013-1917-1 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 214 TITLE Multileaf collimation cardiac shielding in breast radiotherapy: Cardiac doses are reduced, but at what cost? AUTHOR NAMES Bartlett F.R. Yarnold J.R. Donovan E.M. Evans P.M. Locke I. Kirby A.M. AUTHOR ADDRESSES (Bartlett F.R., frederick.bartlett@rmh.nhs.uk; Yarnold J.R.; Locke I.; Kirby A.M.) Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom. (Yarnold J.R.) Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom. (Donovan E.M.; Evans P.M.) Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom. (Evans P.M.) Centre for Vision, Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, United Kingdom. CORRESPONDENCE ADDRESS F.R. Bartlett, Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, United Kingdom. Email: frederick.bartlett@rmh.nhs.uk SOURCE Clinical Oncology (2013) 25:12 (690-696). Date of Publication: December 2013 ISSN 0936-6555 1433-2981 (electronic) BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Aims: To measure cardiac tissue doses in left-sided breast cancer patients receiving supine tangential field radiotherapy with multileaf collimation (MLC) cardiac shielding of the heart and to assess the effect on target volume coverage. Materials and methods: Sixty-seven consecutive patients who underwent adjuvant radiotherapy to the left breast (n=48) or chest wall (n=19) in 2009/2010 were analysed. The heart, left anterior descending coronary artery (LAD), whole breast and partial breast clinical target volumes (WBCTV and PBCTV) were outlined retrospectively (the latter only in patients who had undergone breast-conserving surgery [BCS]). The mean heart and LAD NTD(mean) and maximum LAD doses (LAD(max)) were calculated for all patients (NTD(mean) is a biologically weighted mean dose normalised to 2Gy fractions using a standard linear quadratic model). Coverage of WBCTV and PBCTV by the 95% isodose was assessed (BCS patients only). Results: The mean heart NTD(mean) (standard deviation) was 0.8 (0.3) Gy, the mean LAD NTD(mean) 6.7 (4.3) Gy and the mean LAD(max) 40.3 (10.1) Gy. Coverage of the WBCTV by 95% isodose was <90% in one in three patients and PBCTV coverage <95% (range 78-94%) in one in 10 BCS patients. Conclusion: The use of MLC cardiac shielding reduces doses to cardiac tissues at the expense of target tissue coverage. Formal target volume delineation in combination with an assessment of the likelihood of local relapse is recommended in order to aid decisions regarding field and MLC placement. © 2013 The Royal College of Radiologists. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) cancer radiotherapy multileaf collimator radiation dose radiation protection target organ EMTREE MEDICAL INDEX TERMS adult article cancer recurrence decision making female heart human left anterior descending coronary artery major clinical study medical record review partial mastectomy priority journal radiation dose fractionation retrospective study thorax wall treatment planning EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013694213 MEDLINE PMID 24083961 (http://www.ncbi.nlm.nih.gov/pubmed/24083961) PUI L52795653 DOI 10.1016/j.clon.2013.09.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.clon.2013.09.002 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 215 TITLE Facilitating decision making of women considering breast reconstruction following mastectomy: Results from a randomised controlled trial of the breconda web-based decision aid AUTHOR NAMES Sherman K. Harcourt D. Lam T. Boyages J. Brown P. Cameron L. Shaw L.-K. Winch C. AUTHOR ADDRESSES (Sherman K.; Shaw L.-K.; Winch C.) Macquarie University, North Ryde, Australia. (Sherman K.; Lam T.) Westmead Breast Cancer Institute, Westmead, Australia. (Harcourt D.) University of the West of England, Bristol, United Kingdom. (Lam T.; Boyages J.) Macquarie University Cancer Institute, North Ryde, Australia. (Brown P.; Cameron L.) University of California, Merced, United States. CORRESPONDENCE ADDRESS K. Sherman, Macquarie University, North Ryde, Australia. SOURCE Psycho-Oncology (2013) 22 SUPPL. 3 (22-23). Date of Publication: November 2013 CONFERENCE NAME 15th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-11-04 to 2013-11-08 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Women requiring mastectomy for breast cancer are faced with the difficult preference- based decision regarding whether, and how, to restore breast shape after surgery. We have developed a web-based interactive decision aid, BRECONDA, to assist with this decision-making. Detailed information about type and timing of breast reconstruction surgical choices, interactive values clarification exercises, and video recorded patient interviews are provided. In a randomised controlled trial we compared the efficacy of BRECONDA with a general educational pamphlet. METHOD: Women diagnosed with breast cancer were recruited into the entirely web-based trial either prior to (n = 31) or after mastectomy (n = 107). Following consent, participants completed baseline questionnaires and were then randomly assigned into either: 1) Intervention (INT) - received unlimited access to the BRECONDA program and an electronic version of an information booklet about breast surgery and reconstruction; or, 2) Control (CONT) - received the information booklet alone. Participants then completed 1- month follow-up questionnaires. Assessments included satisfaction with information, decisional conflict and knowledge. INT participants completed ratings of perceived usefulness of the intervention and appropriateness and extent of the content. RESULTS: By 1-month follow-up, 26 participants (16 CONT; 10 INT) had undergone breast reconstruction. Controlling for baseline knowledge, time since diagnosis, current reconstruction and mastectomy status, ANCOVAs demonstrated that at follow-up INT participants reported significantly lower decisional conflict (INT = 27.3; CONT = 34.6, p = 0.015) and greater satisfaction with information (INT = 4.02; CONT = 3.74, p= 0.033); both groups had equally high knowledge (INT = 8.58; CONT = 8.41; out of 10; p= 0.47). The majority (>75%) of INT participants indicated high to very high overall satisfaction with the intervention, reporting that it was easy to use, presented a balanced view and that the amount of information provided was “just right” (75%). CONCLUSIONS: These findings indicate that participants assigned to the intervention benefitted in terms of their overall decisional process quality in that they reported both greater satisfaction with information regarding the breast reconstruction decision and lower decisional conflict. In terms of evaluating the content and format, intervention users reported high levels of user acceptability regarding overall satisfaction with the decision aid, and the appropriateness of the content for the target audience. Given that both conditions had access to quality information about breast reconstruction through the information booklet it is not surprising that knowledge was high in both groups at the 1-month follow-up. RESEARCH IMPLICATIONS: This is the first randomized controlled trial to assess a fully-integrated online decision aid that incorporates values clarification exercises in the breast reconstruction context. These findings provide evidence for the acceptability and efficacy of this decision support intervention in the short term. The intervention was equally as effective for women who had previously undergone mastectomy as for those about to have a mastectomy, suggesting the broad applicability of this decision aid. CLINICAL IMPLICATIONS: Online patient resources such as BRECONDA have the advantage of easy accessibility, particularly with increasing internet access across the broad population. These data support the feasibility and acceptability of implementing BRECONDA into oncological surgery practice. The easy-to-use self-guided format of the intervention will allow surgeons to refer their patients to this resource as an adjunct to medical consultations and to facilitate the decision-making process concerning both immediate and delayed breast reconstruction surgery following mastectomy. EMTREE DRUG INDEX TERMS metronidazole EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision making female human mastectomy oncology randomized controlled trial society EMTREE MEDICAL INDEX TERMS breast breast cancer breast surgery consultation decision support system diagnosis exercise follow up Internet interview patient plastic surgery population questionnaire satisfaction surgeon surgery videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71356446 DOI 10.1111/j.1099-1611.2013.3393 FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2013.3393 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 216 TITLE Informal decision support networks and treatment decisions for breast cancer AUTHOR NAMES Hawley S.T. Janz N.K. Juhasz R. Katz S.J. AUTHOR ADDRESSES (Hawley S.T.; Janz N.K.; Juhasz R.; Katz S.J.) University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI; University of Michigan School of Public Health, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI CORRESPONDENCE ADDRESS S.T. Hawley, SOURCE Journal of Clinical Oncology (2013) 31:31 SUPPL. 1. Date of Publication: 1 Nov 2013 CONFERENCE NAME ASCO's Quality Care Symposium 2013 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2013-11-01 to 2013-11-02 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Although nearly 80% of breast cancer patients have someone with them during surgical consultations, there is little research that examines the extent, nature, or impact of informal decision support persons (DSPs) such as partner/spouse, other family members, or friends on breast cancer treatment decision making. Methods: Two data sources were used: 1) A population based sample of patients recently diagnosed in 2006/7 in the Detroit and Los Angeles SEER catchment areas completed a survey 9 months (N=1837, 72% response rate); and 2) A pilot survey study of a convenience sample of 150 breast cancer patients at three clinical sites surveyed within 18 months that examined more details on the extent and nature of informal decision support networks, including: a) quantity and type of DSPs involved in their treatments, b) number of appointments attended by DSPs, and c) patient-reported satisfaction with DSP's involvement in treatment decision making. Results: Both a spouse/partner and another family member were very important in treatment decision-making for 33% of patients; a spouse/partner alone was very important for 19%; a family member alone was very important for 13%. A spouse/partner or friends were not important in treatment decision making for 24% of patients. Only 19% of patients reported that a friend was very important in treatment decision making. Friends were much more frequently endorsed among patients with family involvement (45%) vs those without family involvement (5%). Latina patients significantly more often reported that the opinion of a family member was very important vs. other race/ethnic groups (71% vs. 39%, p<0.001). Patients in the pilot study reported an average of 2.67 DSPs were involved in locoregional decision making (SD = 2.57 ) vs. an average of 0.8 (SD=1.03) for involvement in systemic treatment decision making. Conclusions: Many breast cancer patients rely on some informal decision support, but there is a very wide variation in the extent and nature of this support. Further work is needed to understand how to best incorporate DSPs into the treatment decision process. Additional findings will be presented to further describe the impact of informal treatment decision support for women with breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system EMTREE MEDICAL INDEX TERMS cancer patient cancer therapy catchment consultation convenience sample decision making female friend human patient pilot study population satisfaction systemic therapy United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71286195 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 217 TITLE Information to design a surgical decision aid for young breast cancer patients AUTHOR NAMES Recio-Saucedo A. Foster C. Gerty S. Cutress R. Eccles D. AUTHOR ADDRESSES (Recio-Saucedo A.; Foster C.; Gerty S.; Cutress R.; Eccles D.) University of Southampton, Southampton, United Kingdom. CORRESPONDENCE ADDRESS A. Recio-Saucedo, University of Southampton, Southampton, United Kingdom. SOURCE Psycho-Oncology (2013) 22 SUPPL. 3 (358-359). Date of Publication: November 2013 CONFERENCE NAME 15th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-11-04 to 2013-11-08 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Breast cancer is the most commonly diagnosed cancer in young women. Treatment at a young age can have significant impact on fertility and child-rearing, prompting the onset of early menopause and ovarian decline. It is not known if young patients diagnosed with breast cancer have specific information needs associated with effects of treatment. Results of an on-going qualitative study to design a decision aid tailored to breast cancer patients diagnosed under 40 years is reported. METHOD: In order to explore young women's information needs, twenty in-depth semistructured interviews with patients who had a diagnosis of breast cancer at 40 years old or younger were conducted. Findings from the interviews were further explored in two focus groups with five patients each. Audio-recorded interviews and focus groups were transcribed verbatim and analysed under a thematic framework approach. RESULTS: Information that young women identified was required to support treatment decisionmaking was categorized in five themes: types of breast cancer, surgical treatments, non-surgical treatments, fertility, and preparing for surgery: before and after. Themes including side effects of treatment, fertility preservation and options for reconstructive surgery were identified as areas that need improvement, emphasising that more information on types of reconstruction and impact of early menopause would have been useful to have. The most important advantage for an online decision aid was access to reliable information that supports understanding of complex facts and risks. CONCLUSIONS: Women identified information relevant to them at the time of treatment decisionmaking as well as information that might have been useful. An online decision aid tailored for young women is relevant considering age-related needs that influence surgical treatment for breast cancer. RESEARCH IMPLICATIONS: This study has identified ambiguity in the definition of young age for breast cancer patients, ranging between 40 up to 50 years old. This variation may be a factor in the ways that other aspects of treatment are presented to patients, including fertility preservation and options of immediate or delayed reconstruction. There is a need to determine an age threshold for young patients, which may be applicable at international level. CLINICAL IMPLICATIONS: Patients with access to the most relevant information to them at the time of making a treatment decision may choose to play a role in their treatment, supporting a shared-decision making model. Clinicians may face potential changes in the patient-provider relationship from the paternalistic model to one where patients will feel more prepared to voice their concerns, values and preferences on the treatment path chosen. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human oncology society EMTREE MEDICAL INDEX TERMS ambiguity child rearing decision making diagnosis early menopause female fertility fertility preservation information processing interview model neoplasm patient plastic surgery qualitative research risk semi structured interview side effect surgery voice LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71356977 DOI 10.10002/pon.3394 FULL TEXT LINK http://dx.doi.org/10.10002/pon.3394 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 218 TITLE 'Navigation' for high grade brain tumour patients. A longitudinal qualitative evaluation of a shared decision making intervention AUTHOR NAMES Shepherd S. Hacking B. Wallace L. Scott S. Bowyer D. Belkora J. AUTHOR ADDRESSES (Shepherd S.; Wallace L.; Scott S.; Bowyer D.) Coventry University, Coventry, United Kingdom. (Shepherd S.; Hacking B.; Scott S.; Bowyer D.) Edinburgh Cancer Centre, NHS lothian, Edinburgh, United Kingdom. (Belkora J.) University of California, San Francisco, United States. CORRESPONDENCE ADDRESS S. Shepherd, Coventry University, Coventry, United Kingdom. SOURCE Psycho-Oncology (2013) 22 SUPPL. 3 (68-69). Date of Publication: November 2013 CONFERENCE NAME 15th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-11-04 to 2013-11-08 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: In medical consultations the need to know and understand what is happening and the need to feel known and understood by the Doctor are recognised as fundamental patient needs. Many High Grade brain tumour patients describe a lack of specific information about their condition, treatment and 'what's next.' This unique study explores the experiences of Navigation with HGG patients. Navigation is a communication and decision support intervention, evaluated successfully in prostate and breast cancer patients. METHOD: Patients (n = 20) attending the Edinburgh Neuro-oncology Centre diagnosed with a High Grade brain tumour participated in Navigation and serial evaluation interviews. Patients were navigated for three oncology clinic appointments over 6 months. Interviews were undertaken at baseline and after navigated clinic appointments. Framework analysis was undertaken. Navigation involves question listing, recording and summarising. Prior to oncology consultations, Navigators helped patients create a list of their questions for use in the consultation. Subsequently, patients were given an audio recording of their consultation (CD) and a written record of the key points discussed. RESULTS: Preliminary themes: • Preparing to discuss: Taking time to create a question list afforded patients the clarity to understand what it was they actually wanted to talk to their oncologist about. • A consultation tailored to me: Patients felt confident to take part in the consultation and ask questions. They felt the consultants provided personalised information. • Facilitating understanding and memory: Summaries and recordings were used as memory aids, most remembered little. • Difficult to listen again: Some found listening to the CD hard, e.g. to hear phrases such as “incurable,” but felt able to return to it when ready. CONCLUSIONS: High grade brain tumour patients described positive experiences of Navigation. Preliminary results indicate Navigation is enhancing the current service for patients through the individualised preparation of questions for consultations and the provision of tailored memory aids for patients to review. This study draws on self efficacy theory and the decision conflict model. Results suggest Navigation facilitated patients to meet the need to feel known and understood in their consultation by helping them create a question list. It also facilitated the need to understand through providing tools to ask questions, and to remember through the provision of consultation summary and CD. RESEARCH IMPLICATIONS: Further research is needed to identify the impact of using a Navigator to help patients create a question list versus patients doing this alone. Evaluation of the impact of Navigation on oncology consultants and GPs is being carried out. It will be important to understand how this intervention can be embedded as routine. CLINICAL IMPLICATIONS: Results suggest encouraging patients to take time to prepare may ensure a more effective medical consultation. Patients responded positively to having a record of their consultation. Providing high grade brain tumour patients with aids to help recall could prevent contact with healthcare staff that is avoidable. In Scotland it is not common place to provide patients with clinic outcome letters, the results of this study may support this practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain tumor decision making human oncology patient society EMTREE MEDICAL INDEX TERMS audio recording breast cancer cancer patient consultation decision support system health care hospital interpersonal communication interview male memory model oncologist physician prostate recall recording Social Cognitive Theory United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71356516 DOI 10.1111/j.1099-1611.2013.3393 FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2013.3393 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 219 TITLE Use of a values clarification exercise about fertility preservation leads to more clarity about values and more knowledge in healthy participants AUTHOR NAMES Garvelink M. Ter Kuile M. Stiggelbout A. Vries M. AUTHOR ADDRESSES (Garvelink M.; Ter Kuile M.) Department of Gynecolog, Leiden University Medical Center, Leiden, South Holland, Netherlands. (Stiggelbout A.) Department of Medical Decision Making, Leiden University Medical Center, Leiden, South Holland, Netherlands. (Vries M.) Department of Social Psychology, Tilburg University, Tilburg, North Brabant, Netherlands. CORRESPONDENCE ADDRESS M. Garvelink, Department of Gynecolog, Leiden University Medical Center, Leiden, South Holland, Netherlands. SOURCE Psycho-Oncology (2013) 22 SUPPL. 3 (354-355). Date of Publication: November 2013 CONFERENCE NAME 15th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-11-04 to 2013-11-08 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: To improve information provision about fertility preservation (FP) and support informed decision making for young breast cancer patients, a decision aid (DA) with explicit values clarification exercise (VCE) was developed. We found that healthy respondents who used the VCE reported less decisional conflict compared to those who did not, but few respondents had used the VCE. The current experiment studies the relation between personality, DA-use and decisional conflict with or without referral to the VCE. METHOD: Healthy participants (n = 193) were randomized between information only(VCE-), information+ VCE without referral to the VCE (VCE+), or information+VCE with referral to the VCE (VCE++) and were asked to make a hypothetical decision regarding FP. Measures were personality traits (neuroticism, conscientiousness, monitoring, blunting), DA-use (time spent, pages viewed, VCEuse), decisional conflict (including subscales), and knowledge. RESULTS: More women in VCE++ used the VCE (85%) compared to VCE+ (57%; OR = 4.47, p < 0.001). There were no differences in decisional conflict or knowledge between conditions (-/++), mean absolute knowledge between baseline and post-DA was 40%. Secondary analyses revealed that blunting was univariately associated with fewer pages viewed (B = -0.734 SE = 0.23, p < 0.01), monitoring with more time spent on the DA (B = 21.01 SE = 9.75 p < 0.05). Within VCE+/++, VCE-use was related to more values clarity (M = 37.1(SD = 14.3); M = 31.1 (SD = 14.7) p < 0.05). There was an interaction between group x conscientiousness and VCE-use (OR = 4.3 p = 0.038); conscientiousness was positively related to VCE-use in VCE++, and not related to VCE-use in VCE+. CONCLUSIONS: Our DA leads to increased knowledge in a healthy population making a hypothetical decision. There were no differences with regard to knowledge or decisional conflict. Secondary analyses suggest a relation between VCE-use and values clarity, and between conscientiousness and VCE-use in the referred group. The extent of use of the total DA was related to monitoring and blunting information seeking styles. Therefore, personality (with regard to information seeking) might be an important factor explaining the extent to which a DA is used, and the effectiveness of DAs . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) exercise fertility preservation human oncology society EMTREE MEDICAL INDEX TERMS breast cancer cancer patient decision making female information seeking monitoring neurosis personality population secondary analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71356971 DOI 10.10002/pon.3394 FULL TEXT LINK http://dx.doi.org/10.10002/pon.3394 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 220 TITLE Development of a patient-centered decision aid to improve accuracy of breast cancer risk perception AUTHOR NAMES Xiao T. Crew K.D. Sivasubramanian P.S. Aguirre A.N. Smalletz C.K. Kukafka R. AUTHOR ADDRESSES (Xiao T.) Columbia University, Mailman School of Public Health, New York, United States. (Crew K.D.) Herbert Irving Comprehensive Cancer Center, Columbia University, New York, United States. (Sivasubramanian P.S.) New York Presbyterian Hospital, Columbia University, New York, United States. (Aguirre A.N.) Columbia Community Partnership For Health, New York, United States. (Smalletz C.K.) Columbia Center for New Media Teaching and Learning, New York, United States. (Kukafka R.) Department of Biomedical Informatics, Columbia University, New York, United States. CORRESPONDENCE ADDRESS T. Xiao, Columbia University, Mailman School of Public Health, New York, United States. SOURCE Cancer Prevention Research (2013) 6:11 SUPPL. 1. Date of Publication: November 2013 CONFERENCE NAME 12th Annual AACR International Conference on Frontiers in Cancer Prevention Research CONFERENCE LOCATION National Harbor, MD, United States CONFERENCE DATE 2013-10-27 to 2013-10-30 ISSN 1940-6207 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Breast cancer risk assessment and interventions for prevention, such as chemoprevention, are underutilized in the U.S. Reasons for low uptake include inability to routinely screen for high-risk women in the primary care setting, inadequate time for counseling, and insufficient knowledge about risk-reducing strategies. We developed an initial prototype of a web-based decision aid (DA), RealRisks, which incorporates experience-based dynamic interfaces to communicate risk aimed at reducing inaccurate risk perceptions, particularly in low-numerate populations. Methods: RealRisks is a patient DA that models patient-provider dialogue with modules on breast cancer risk, genetic testing, and chemoprevention. Embedded within the narrative are 2 games of experience-based risk interfaces, demonstrating average 5-year and lifetime breast cancer risk. Both games ask players to sample from a pictograph of 100 clickable women to better learn the meaning of a pre-set probability (i.e., 12 out of 100 women or 12%). We conducted four focus groups of 7-9 English-speaking women over the age of 18, recruited from the local community in Upper Manhattan in New York City. These recorded sessions lasted about 90 minutes and involved use of RealRisks on a laptop, questionnaire completion before and after interacting with the DA, and a semi-structured group discussion. Questionnaires included information about demographics, numeracy, internet access, breast cancer risk factors, perceived breast cancer risk, and evaluation of RealRisks on a 7-point Likert scale. Descriptive statistics were generated to document baseline characteristics and frequencies of positive and negative attitudes about RealRisks. Paired t-test and McNemar's test were used to compare within-individual changes in accuracy of perceived breast cancer risk. During the group discussion, verbal responses were condensed into themes using a qualitative approach. Results: From May to June 2013, 34 women were enrolled. Median age was 53.5 (range, 35-75); 85% were either black or Hispanic; 41% met criteria for low numeracy; and 88% had internet access. After removing 3 women with a history of breast cancer, 3 (9.7%) met high-risk criteria for breast cancer according to the Gail model (≥1.67% 5-year risk) and mean 5-year and lifetime breast cancer risk were 1.11% (±0.77) and 7.46% (±2.87), respectively. After interacting with RealRisks, the difference in perceived vs. actual breast cancer risk according to the Gail model significantly improved for 5-year risk (p=0.008), but not lifetime risk (p=0.20). Before exposure to RealRisks, 52% had accurate breast cancer risk perceptions (defined as within ±5% of actual lifetime risk according to the Gail model) compared to 70% after RealRisks (p=0.10). In particular, 4 out of 5 women who overestimated their lifetime breast cancer risk by >30% had accurate risk perceptions after exposure to RealRisks. We found a significant association between numeracy and accuracy of risk perception after interacting with RealRisks (p=0.05). Over 85% of the participants thought RealRisks was useful, easy to use, increased their knowledge about breast cancer and understanding of breast cancer risk factors. From the focus group discussions, we found that knowledge about breast cancer risk factors, apart from family history, was limited. Participants were interested in receiving a personalized breast cancer risk assessment and found the interactive games engaging. Discussion: In a multi-ethnic low-numerate population, we demonstrated a significant improvement in accuracy of perceived breast cancer risk after exposure to RealRisks. Based upon feedback from our focus groups, we were able to identify information needed to fully represent the important issues of breast cancer risk to further develop our prototype for testing in a randomized controlled trial. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer prevention cancer risk human patient EMTREE MEDICAL INDEX TERMS chemoprophylaxis community counseling exposure family history feedback system female genetic screening Hispanic information processing Internet lifespan Likert scale McNemar test model narrative population prevention primary medical care questionnaire randomized controlled trial risk risk assessment risk factor speech statistics Student t test United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71670373 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 221 TITLE Strategies to reduce variation in the use of surgery AUTHOR NAMES McCulloch P. Nagendran M. Campbell W.B. Price A. Jani A. Birkmeyer J.D. Gray M. AUTHOR ADDRESSES (McCulloch P., peter.mcculloch@nds.ox.ac.uk; Nagendran M.) Nuffield Department of Surgical Science, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. (Price A.) Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, United Kingdom. (Campbell W.B.) Interventional Procedures Advisory Committee, National Institute for Health and Care Excellence, London, United Kingdom. (Jani A.; Gray M.) QIPP Right Care Program, Department of Health, Oxford, United Kingdom. (Birkmeyer J.D.) Department of Surgery, University of Michigan, Ann Arbor, MI, United States. CORRESPONDENCE ADDRESS P. McCulloch, Nuffield Department of Surgical Science, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. Email: peter.mcculloch@nds.ox.ac.uk SOURCE The Lancet (2013) 382:9898 (1130-1139). Date of Publication: 2013 ISSN 0140-6736 1474-547X (electronic) BOOK PUBLISHER Lancet Publishing Group, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Provision rates for surgery vary widely in relation to identifiable need, suggesting that reduction of this variation might be appropriate. The definition of unwarranted variation is difficult because the boundaries of acceptable practice are wide, and information about patient preference is lacking. Very little direct research evidence exists on the modification of variations in surgery rates, so inferences must be drawn from research on the alteration of overall rates. The available evidence has large gaps, which suggests that some proposed strategies produce only marginal change. Micro-level interventions target decision making that affects individuals, whereas macro-level interventions target health-care systems with the use of financial, regulatory, or incentivisation strategies. Financial and regulatory changes can have major effects on provision rates, but these effects are often complex and can include unintended adverse effects. The net effects of micro-level strategies (such as improvement of evidence and dissemination of evidence, and support for shared decision making) can be smaller, but better directed. Further research is needed to identify what level of variation in surgery rates is appropriate in a specific context, and how variation can be reduced where desirable. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care planning hospital finance surgery EMTREE MEDICAL INDEX TERMS abdominal aorta aneurysm (surgery) adverse outcome article bariatric surgery breast cancer (surgery) carotid endarterectomy cataract extraction cesarean section cholecystectomy clinical decision making coronary artery surgery cost effectiveness analysis cryosurgery decision support system doctor patient relation endovascular aneurysm repair evidence based practice funding health care need health care system health insurance hip arthroplasty hip osteoarthritis (surgery) hospital charge human hysterectomy intervertebral disk hernia (surgery) knee arthroplasty knee osteoarthritis (surgery) mastectomy medical fee medical research menorrhagia (surgery) metal on metal joint prosthesis minor surgery morbidity organ transplantation partial mastectomy patient autonomy patient decision making patient participation patient preference postgraduate education practice guideline priority journal professional development prostate hypertrophy (surgery) protocol compliance spinal cord surgery surgical mortality surgical training systematic review (topic) total quality management transurethral resection vaginal delivery verruca vulgaris (surgery) EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013607638 MEDLINE PMID 24075053 (http://www.ncbi.nlm.nih.gov/pubmed/24075053) PUI L369896093 DOI 10.1016/S0140-6736(13)61216-7 FULL TEXT LINK http://dx.doi.org/10.1016/S0140-6736(13)61216-7 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 222 TITLE Implementing patient-oriented decision support into breast cancer care AUTHOR NAMES Fowble B.L. Belkora J. Volz S. Esserman L. AUTHOR ADDRESSES (Fowble B.L.; Belkora J.; Volz S.; Esserman L.) University of California San Francisco, San Francisco, United States. CORRESPONDENCE ADDRESS B.L. Fowble, University of California San Francisco, San Francisco, United States. SOURCE International Journal of Radiation Oncology Biology Physics (2013) 87:2 SUPPL. 1 (S39-S40). Date of Publication: 1 Oct 2013 CONFERENCE NAME 55th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2013 CONFERENCE LOCATION Atlanta, GA, United States CONFERENCE DATE 2013-09-22 to 2013-09-25 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): A multidisciplinary approach to breast cancer treatment provides optimal care. However, the decision making process can be overwhelming for the individual patient. Decision aids (DAs) educate patients about treatment options and outcomes. Communication aids (CAs) help patients identify questions for their physicians and provide written summaries and audio-recordings of consultations. We examined the effect of DAs and CAs on communication and treatment decision making in our breast cancer clinic. Materials/Methods: DAs/CAs were integrated into our breast cancer clinic in 2005. Trained counselors provided patients with educational written materials and videos from Informed Medical Decisions Foundation and assisted them in creating and prioritizing a list of questions before their physician visits (surgeons, radiation oncologists, medical oncologists, and plastic surgeons). The counselors accompanied patients on each visit. They were given written summaries and audio recordings of visits. Software, internet, and telephone communications were used to track and deliver the services. Patients were surveyed before and after receiving DAs/CAs using O'Connor's Decisional Conflict Scale (DCS) which measures patient uncertainty regarding the best course of action (scale 1-5; lower scores more certainty) and knowledge items from Sepucha's Decision Quality Instrument (DQI) which reflects an informed choice. Custom instruments measured question self-efficacy (confidence patient knows what questions to ask) and satisfaction with DAs/CAs on a scale of 0 to 10 (maximum). Results: Between 2005 and 2010, DAs grew annually from 208 to 1,027 (total 3,208) while CAs grew annually from 142 to 348 (total 1,228). Post- DA surveys found an increase in patient knowledge (correct responses) from 45% to 74%; decrease in decision conflict scores (2.61 to 2.09) (p < 0.001). Post-CA survey found increase in the number of patient questions (9 to 24) and question self-efficacy (6.7 to 8.1) (p < 0.001). Follow-up survey of DAs and CAs found satisfaction 8.9/10. In 2009-2010, 83% of 1,355 new patients were offered CAs: 67% accepted the offer. Follow-up surveys found that 76% viewed DA videos and 93% read DA booklets. Eighty-three percent reviewed their consultation summaries and 56% reviewed the audio-recordings. Conclusions: We have effectively integrated DAs and CAs into routine breast cancer care. We have demonstrated a positive effect on patientphysician communication, a greater satisfaction with the physician consultation and an improved understanding of treatment options; all of which facilitate the decision-making process. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system human oncology patient society EMTREE MEDICAL INDEX TERMS audio recording cancer center cancer therapy communication aid consultation decision making follow up hospital patient Internet interpersonal communication medical oncologist non profit organization physician plastic surgeon radiation oncologist satisfaction self concept software surgeon telephone videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71185567 DOI 10.1016/j.ijrobp.2013.06.105 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2013.06.105 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 223 TITLE Predictors of readmission after breast reconstruction: a multi-institutional analysis of 5012 patients AUTHOR NAMES Mlodinow A.S. Ver Halen J.P. Lim S. Lim S. Nguyen K.T. Gaido J.A. Kim J.Y. AUTHOR ADDRESSES (Mlodinow A.S.; Ver Halen J.P.; Lim S.; Lim S.; Nguyen K.T.; Gaido J.A.; Kim J.Y.) From the *Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL; †Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN; and ‡Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL SOURCE Annals of plastic surgery (2013) 71:4 (335-341). Date of Publication: 1 Oct 2013 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures.METHODS: Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database. Patients were grouped as purely immediate implant/tissue-expander reconstructions or purely autologous reconstruction for analysis. Reconstructions involving multiple types of procedures were excluded due to difficulty with classification. Perioperative variables were analyzed using χ and Student t test as appropriate. Multivariate regression modeling was used to identify risk factors for readmission.RESULTS: Of 5012 patients meeting inclusion criteria, 3960 and 1052 underwent implant/expander and autologous reconstructions, respectively. Implant/expander and autologous cohorts experienced similar readmission rates (4.34% vs 5.32%, respectively; P = 0.18). However, autologous reconstructions experienced a higher rate of overall complications than implant/expander reconstructions (19.96% vs 5.86%, respectively; P < 0.05), as well as higher rates of reoperation (9.7% vs 6.5%, respectively; P < 0.05). Common predictors of readmission for implant/expander and autologous cohorts included operative time, American Society of Anesthesiologist class 3 and 4, and superficial surgical site infection. Smoking, sepsis, deep wound infection, organ space infection, and wound disruption were predictive of readmission for implant/expander reconstruction only, whereas hypertension was predictive of readmission after autologous reconstruction only.CONCLUSIONS: This is the first study of readmission rates after breast reconstruction. Knowledge of specific risk factors for readmission may improve patient outcomes, steer strategies for optimizing reconstructive outcomes, and minimize readmissions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction statistics and numerical data EMTREE MEDICAL INDEX TERMS adult breast augmentation breast implant breast tumor (surgery) clinical trial decision support system devices evaluation study factual database female hospital readmission human mastectomy middle aged multicenter study multivariate analysis postoperative complication (epidemiology, surgery) procedures reoperation retrospective study risk factor statistical model surgical flaps tissue expander transplantation treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24025652 (http://www.ncbi.nlm.nih.gov/pubmed/24025652) PUI L603748071 DOI 10.1097/SAP.0b013e3182a0df25 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e3182a0df25 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 224 TITLE Proceedings of the American Society for Radiation Oncology 55th Annual Meeting, ASTRO 2013 AUTHOR ADDRESSES SOURCE International Journal of Radiation Oncology Biology Physics (2013) 87:2 SUPPL. 1. Date of Publication: 1 Oct 2013 CONFERENCE NAME 55th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2013 CONFERENCE LOCATION Atlanta, GA, United States CONFERENCE DATE 2013-09-22 to 2013-09-25 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT The proceedings contain 1,951 papers. The topics discussed include: predictive modeling of outcomes following definitive chemoradiation therapy for oropharyngeal cancer based on FDGPET image characteristics; radiation therapy oncology group (RTOG) Protocol 0915: a randomized phase 2 study comparing 2 stereotactic body radiation therapy (SBRT) schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer; survival and neurocognitive outcomes following addition of a cranial or craniospinal boost to total body irradiation prior to stem cell transplantation in pediatric leukemia patients with CNS involvement; comparison of NCCN and ACR guidelines regarding treatment of lung, prostate, and head-and-neck cancers; implementing patient-oriented decision support into breast cancer care; and multiple pathology reviews in prostate cancer diagnosis, prevalence of use in the medicare population, and cost implications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) oncology society EMTREE MEDICAL INDEX TERMS breast cancer cancer diagnosis central nervous system chemoradiotherapy decision support system head and neck cancer human leukemia lung male medicare model non small cell lung cancer oropharynx cancer pathology patient phase 2 clinical trial population prevalence prostate prostate cancer radiotherapy stem cell transplantation stereotactic body radiation therapy survival therapy whole body radiation LANGUAGE OF ARTICLE English PUI L71187425 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 225 TITLE Decisional support for women 60 years and older during their treatment for stage I and II breast cancer: A single institutional study AUTHOR NAMES Szumacher E. D'Alimonte L. Presutti R. McGuffin M. Chow E. Pignol J. Di Prospero L. Doherty M. Kiss A. Warner E. AUTHOR ADDRESSES (Szumacher E.; D'Alimonte L.; Presutti R.; McGuffin M.; Chow E.; Pignol J.; Di Prospero L.; Doherty M.; Kiss A.; Warner E.) Sunnybrook Health Sciences Centre, Toronto, Canada. CORRESPONDENCE ADDRESS E. Szumacher, Sunnybrook Health Sciences Centre, Toronto, Canada. SOURCE International Journal of Radiation Oncology Biology Physics (2013) 87:2 SUPPL. 1 (S501). Date of Publication: 1 Oct 2013 CONFERENCE NAME 55th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2013 CONFERENCE LOCATION Atlanta, GA, United States CONFERENCE DATE 2013-09-22 to 2013-09-25 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Women 60 years and older often feel less assertive when making their breast cancer-treatment decisions and may not have sufficient support offered by their health-care teams. To determine if older women treated at Odette Cancer Center with Stage I and II breast cancer have sufficient support in making cancer treatment decisions. Materials/Methods: Patients 60 years and older, post-lumpectomy, with Stage I and II, invasive breast carcinoma (IBC) were eligible. Patients were contacted upon completion of their treatments and were asked to complete a 50-item questionnaire. The questionnaire investigated patients' information support surrounding breast cancer diagnosis, the impact of diagnosis on patients' lives, quality of interaction and support from their healthcare teams. Results: A total of 97/137 patients participated. Eighty-nine percent were ≤60 years at the time of diagnosis and 95% were Stage I or II IBC. Twenty-seven percent of patients received chemotherapy, while 63% received hormone therapy, and 96% received radiation treatment. Ten percent of women indicated that they received low support during their cancer diagnosis. In 56% diagnosis impacted their daily routine and lifestyle. Twenty-one percent received very little or no information about risks, benefits and side-effects before or during their treatment. Seventyone percent of women felt that they actively participated in their treatment decisions. Fifty-eight percent of participants would value a worksheet to list questions for their healthcare teams while discussing their treatment options. Three percent of participants felt that their decisional support during treatment was inadequate. Conclusions: The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer. There are still inadequacies in support based on patients' demographics such as age, chronic comorbidities and education that will be presented at the meeting in details. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female human oncology society EMTREE MEDICAL INDEX TERMS breast carcinoma cancer center cancer diagnosis cancer therapy chemotherapy diagnosis education health care hormonal therapy lifestyle partial mastectomy patient questionnaire radiotherapy risk side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71186750 DOI 10.1016/j.ijrobp.2013.06.1324 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2013.06.1324 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 226 TITLE Singapore Health and Biomedical Congress, SHBC 2013 AUTHOR ADDRESSES SOURCE Annals of the Academy of Medicine Singapore (2013) 42 Supplement 9 (S1) CONFERENCE NAME Singapore Health and Biomedical Congress, SHBC 2013 CONFERENCE LOCATION Max Atria @Singapore Expo, Singapore CONFERENCE DATE 2013-09-27 to 2013-09-28 ISSN 0304-4602 ABSTRACT The proceedings contain 327 papers. The special focus in this conference is on Health and Biomedicine. The topics include: Reducing the rate of postoperative endophthalmitis over 11 years-results of a new intervention using intracameral antibiotics; corpus callosum morphology in first episode and chronic schizophrenia; differences in late cardiovascular mortality following acute myocardial infarction among three major Asian ethnicities; exploring relationship of retinal thickness on optical coherence tomography and visual acuity in patients with diabetic macular edema; medication reconciliation in outpatient hospital clinics; utilising discharge planning tools in an inpatient psychiatric rehabilitation services to promote positive clinical outcomes; seven-point subjective global assessment is more time sensitive than conventional subjective global assessment in detecting nutritional changes; Singapore hospice nurses perspectives about spirituality and spiritual care; enhanced infarct stabilisation and cardiac repair with an injectable PEGylated-fibrinogen hydrogel carrying vascular endothelial growth factor (VEGF); identification of tumour suppressive MicroRNAs in multiple myeloma by pharmacologic unmasking; use of a novel stereographic projection software to calculate precise area of peripheral non-perfusion and its correlation with manual grading; a protocol to reduce inter-reviewer variability in computed tomography measurement of orbital floor fractures; impact of genome wide supported psychosis susceptibility NRGN gene on thalamocortical morphology in schizophrenia; improved outcome of myeloma patients in a tertiary hospital; femoral neck fractures-factors affecting ambulatory status in elderly patients more than 65 years old who underwent hip hemiarthroplsty; exploratory factor analysis of the Zarit burden interview in a multi-ethnic Asian community sample; prevalence, awareness, treatment and control of hypertension among Singapore elderly residential population; predictive factors of unscheduled 15-day hospital readmissions; lost in transition-newly qualified registered nurses and their transition to practice journey; national healthcare group clinical educators reflection on web2.0’s application in enhancing teaching and lifelong learning in medical education; determinants of clarification studies in medical education research; hypoglycemia management of patients with type 2 diabetes in primary care setting; photograph-assisted dietary review amongst type 2 diabetics in primary care; exploring the feasibility of advanced care planning in persons with early cognitive impairment; roles of miR-186 in circulating tumour cells (CTCs)-mediated metastasis in breast cancer; characterisation of the biological and clinical relevance of RUNX genes in natural killer T-cell lymphoma; a randomised controlled trial comparing single-injection and continuous femoral nerve blocks with patient-controlled analgesia; magnetic resonance imaging (MRI) changes in lower limbs in transition to frailty; prevalence of dilutional hyponatraemia in inpatients and outpatients in Singapore; a prospective randomised study on the patency period of the plastic anti-reflux biliary stent; an academic-practice collaboration through simulation learning; a multicentre study of physiotherapists’ knowledge and perceptions in palliative care; post discharge pain experiences following total knee arthroplasty; characteristics of subjective QOL of elderly people with dementia in china and Japan; audit of readmissions to a palliative care unit in a tertiary hospital; factors affecting psychological distress in informal caregivers of Singapore elderly; prevalence of anaemia in patients on aspirin medication in a primary care setting; patient satisfaction with pharmacist-managed hypertension-diabetes-lipids clinic and its relation to medication adherence and beliefs about medication; anthropometric measures and cognition in the Singapore elderly; clinical decision support for high-priority drug-drug interactions; a normative study on the national university health system aphasia screening test; a pilot study on the integration of a cognitive-behavioral therapy-based computer game in the clinical treatment of childhood anxiety; barriers of whole-grain intake among healthcare workers in national healthcare group polyclinics; a novel approach to lead screening; effects of computed tomography contrast on bone scans; prevalence and predictors of employment among the Singaporean elderly; evaluating the impact of inpatient accelerated palliative radiation therapy programme in reducing inpatient hospitalisation; socio-demographic correlates of positive mental health; unravelling the relationship between obesity, schizophrenia and cognition; relationship between measures of mental health and functional impairment in primary care; body mass index of elderly persons in Singapore; improving the influenza and pneumococcal vaccination rate of eligible patients with chronic heart failure; reducing near misses from packing errors in inpatient pharmacy; pharmacy-led smoking cessation clinic in dermatology; investigation of high platelet count in random platelet unit and its viability; public attitudes towards mentally-ill persons in Singapore; revisiting the association between parental bonding and risk for psychopathology; pharmacist reviews and outcomes in nursing homes in Singapore; evaluation of the inpatient smoking cessation programme in tan Tock Seng hospital; community forums are effective in improving osteoporosis knowledge; profile of patients referred for podiatry services in primary care; novel use of tigecycline for multiple myeloma in vitro-alternative non-mitochondrial pathways; linking human leucine-rich repeat kinase 2 (LRRK2) gene mutation to cancer development; haploinsufficiency of TP53 in multiple myeloma; bioactive and conductive collagen scaffold for wound healing augmented by electrical stimulation; systematic discovery of novel cilia and ciliopathy genes through functional genomics in the zebrafish; extracellular matrix-based biohybrid skin substitutes; enzyme sensor system for determination of total cholesterol in human serum; intestinal microbial study of gout patients; differences in gut microbiome between schizophrenic patients and healthy individuals; changes in gait associated with sarcopenia; noncultured cellular grafting for vitiligo-a three-year follow-up study; bariatric surgery and its impact on sleep; clinico-epidemiological profile of moderate to severe paediatric atopic dermatitis; influenza vaccination of healthcare workers; a snapshot of audits in the phototherapy unit; a naturalistic longitudinal study in healthy children; retrospective study on autoimmune blistering disease in paediatric patients; association between CHA65S2 score and obstructive sleep apnoea; primary localised cutaneous amyloidosis; high STOP-BANG scores herald adverse perioperative outcomes; neurobehavioral outcomes after traumatic brain injury; extended outcomes by dialysis modality selection in incident patients with end-stage renal disease and ischaemic cardiomyopathy; laparoscopic gastrectomies in gastric cancer patients; survey on factors influencing medication adherence in psychiatric patients; serum brain-derived neurotrophic factor and metabolic indices in patients with schizophrenia; outcomes of non-Tbitrauma patients in a surgical intensive care unit; evaluation of patients screened for MERS-CoV infection at tan Tock Seng hospital, Singapore; thinking twice before using the LMA for obese and older patients-a prospective observational study; comparison study between two apheresis machines; diabetes knowledge in older adults with type 2 diabetes in Singapore; establishing an intensive care unit database; necrotising fasciitis of the head and neck; diabetic chronic kidney disease patients should increase protein intake; the skin-endocrine axis in the management of dermatology patients; dematiaceous mycoses of the skin in Singapore from 2003 to 2010; profile of hearing aids users in Singapore; factors that affect the degree of hearing loss at presentation and hearing aid usage; cross diagnostic comparisons of quality of life between schizophrenia and bipolar disorder patients; value of hearing questionnaire in predicting hearing impairment; utility of self-perception of hearing loss questions in predicting hearing impairment; burnout, challenges and supportive factors in hospital doctors; exploring stereotypes in healthcare professions; health sciences virtual hospital game as a learning tool in nursing education; application of the RIME framework for education administrators’ competencies; bed exit alarm as a novel tool for fall prevention; when prolonged preoperative fasting is a myth; time-motion study for nursing aides activities in a psychiatric hospital; impact of an advanced practice nurse-led heart failure clinic in a secondary hospital in Singapore; managing individuals with diabetes using the diabetes ambulatory stabilisation services (DASS); streamlining process flow for maintenance of 12-lead ECG machine in a cardiology ward; factors of rehabilitation outcomes in primary care physiotherapy; dietary intake of wholegrains of healthcare workers in national healthcare group polyclinics; management of patients with diabetes in two primary care podiatry clinics; preliminary evaluation of shoulder conditions in primary care physiotherapy; prevalence of alcohol problems among elderly in Singapore; prevalence and predictors of tobacco use in elderly Singaporeans; mortality predictors for operative hip fracture patients; a risk index to predict 30 days emergency hospital readmission; compliance of preoperative chest X-rays in anaesthesia clinic; predictors of mortality in patients with chronic kidney disease; continuity of care issues in the Singapore health system; factors influencing patients adherence to follow-up post bariatric surgery; a snapshot of audits in the phototherapy unit; health screening perceptions in Singapore-a grounded theory study; interactive dashboard for monitoring operating theatre operational efficiency; reducing violence through the use of structured therapies; early home visits by care coordinators help to reduce hospital readmission rate; evaluation of a workplace nutrition programme at a hospital; a review of the use of electroencephalography in autism spectrum disorder in the past decade; an alternate plastic packaging to reduce threat of e coli contamination; spatial epidemiology of tuberculosis in Singapore; development of a polarised cellular model for Chikungunya virus infection; summer-winter differences in total vitamin D concentrations in Singapore; effect of femoral nerve block on ambulation following total knee arthroplasty; development of a computer-based objective grading system for facial paralysis; a preliminary finding of EEG differences of children with disruptive behaviour disorders in Singapore; sex hormone concentrations in Singaporean men; deciding where to allocate diabetic educational resources; pseudoexfoliation syndrome at a Singapore eye clinic; corneal thickness in Asian keratoconus patients; reasons influencing non-adherence to medications in psychiatric patients; pilot study on nurses’ perceptions towards different aspects of learning; oral conditions among dependent community-dwelling elderly persons; knowledge of osteoporosis among Singapore adults in national healthcare group polyclinics (NHGP) settings and knowledge adequacy of diagnosis and treatment plans of elderly patients on discharge from tertiary hospital. EMTREE DRUG INDEX TERMS acetylsalicylic acid alcohol antibiotic agent brain derived neurotrophic factor collagen fibrinogen leucine rich repeat kinase 2 lipid microRNA plastic sex hormone tigecycline vasculotropin vitamin D EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health Singapore EMTREE MEDICAL INDEX TERMS acute heart infarction administrative personnel adult advanced practice nurse aged amyloidosis anemia anesthesia anxiety aphasia apheresis Asian atopic dermatitis autism bariatric surgery biliary stent biomedicine bipolar disorder body mass bone scintiscanning book breast cancer burnout cancer patient cardiology cardiovascular mortality caregiver chikungunya child childhood China cholesterol blood level chronic kidney failure circulating tumor cell clinical audit cognition cognitive defect cognitive therapy community community sample computer computer assisted tomography contamination cornea thickness corpus callosum data base decision support system dementia dermatology diabetes mellitus diabetic macular edema diagnosis dialysis diet restriction dietary intake diseases disruptive behavior distress syndrome drug interaction drug therapy education electrocardiogram electroencephalogram electroencephalography electrostimulation employment endophthalmitis enzymic biosensor epidemiology Escherichia coli ethnicity eukaryotic flagellum extracellular matrix eye facial nerve paralysis factor analysis fasciitis femoral neck fracture femoral nerve follow up fracture functional disease functional genomics gait gastrectomy gene gene mutation genome gout grain grounded theory haploinsufficiency health care health care personnel health science hearing hearing aid hearing impairment heart failure hip hip fracture hospice hospital hospital discharge hospital patient hospital physician hospital readmission human hydrogel hypertension hypoglycemia hyponatremia in vitro study infarction infection influenza influenza vaccination injection intensive care unit interview intestine intracameral drug administration ischemic cardiomyopathy Japan keratoconus kidney failure learning leg lifelong learning literature longitudinal study machine male mass screening medical education medication compliance medication therapy management mental disease mental health mental hospital mental patient metastasis microbiome mobilization model monitoring morphology mortality multicenter study multiple myeloma mycosis myeloma neck neoplasm nerve block NK T cell lymphoma non insulin dependent diabetes mellitus nuclear magnetic resonance imaging nurse nursing assistant nursing education nursing home nutrition obesity observational study occupation operating room optical coherence tomography orbit osteoporosis outpatient outpatient department outpatient department packaging pain palliative therapy patient patient care patient controlled analgesia patient satisfaction perfusion pharmacist pharmacy photography phototherapy physiotherapist physiotherapy pilot study planning podiatry population prevalence prevention primary medical care professional practice protein intake pseudoexfoliation psychosis quality of life questionnaire radiotherapy randomized controlled trial registered nurse rehabilitation rehabilitation center religion retinal thickness retrospective study risk sarcopenia schizophrenia screening screening test self concept serum shoulder simulation skin sleep sleep disordered breathing smoking cessation software spiritual care stereotypy stomach cancer summer teaching tertiary health care therapy thorax radiography thrombocyte thrombocyte count tobacco total knee arthroplasty traumatic brain injury tuberculosis university vaccination violence visual acuity vitiligo ward winter workplace wound healing zebra fish LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L75001076 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 227 TITLE A simple and reproducible prognostic index in luminal ER-positive breast cancers AUTHOR NAMES Castellano I. Chiusa L. Vandone A.M. Beatrice S. Goia M. Donadio M. Arisio R. Muscarà F. Durando A. Viale G. Cassoni P. Sapino A. AUTHOR ADDRESSES (Castellano I., isabella.castellano@unito.it; Chiusa L.; Goia M.; Cassoni P.; Sapino A.) Department of Medical Sciences, University of Turin, Turin, Italy. (Vandone A.M.; Beatrice S.; Donadio M.) Division of Oncology, Centro Oncologico Subalpino (COES), Città della Salute e della Scienza, Turin, Italy. (Arisio R.) Departments of Pathology, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy. (Muscarà F.; Durando A.) Departments of Obstetrics and Gynaecology, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy. (Viale G.) Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy. CORRESPONDENCE ADDRESS I. Castellano, Department of Medical Sciences, University of Turin, Via Santena 7, Turin 10126, Italy. Email: isabella.castellano@unito.it SOURCE Annals of Oncology (2013) 24:9 (2292-2297) Article Number: mdt183. Date of Publication: September 2013 ISSN 0923-7534 1569-8041 (electronic) BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Background: The group of estrogen receptor (ER)-positive breast cancers (both luminal-A and -B) behaves differently from the ER-negative group. At least in early follow-up, ER expression influences positively patients' prognosis. This low aggressive biology flattens out the differences of clinical management. Thus we aimed to produce a prognostic index specific for ER-positive (ERPI) cancers that could be of aid for clinical decision. Patients and methods: The test set comprised 495 consecutive ER-positive breast cancers. Tumor size, number of metastatic lymph nodes and androgen receptor expression were the only independent variables related to diseasespecific survival. These variables were used to create the ERPI, which was applied to the entire test set and to selected subpopulations (grade 2 (G2)-tumors, luminal-A and -B breast cancers). A series of 581 ER-positive breast cancers, collected from another hospital, was used to validate ERPI. Results: In the test population, 96.9% of patients classified as ERPI-good showed a good prognosis compared with 79.6% classified as ERPI-poor (P < 0.001). ERPI effectively discriminated outcome in luminal-A and luminal-B and in G2-tumors. In the validation series, the ERPI maintained its value. Conclusion: ERPI is a practical tool in refining the prediction of outcome of patients with ER-positive breast cancer. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) estrogen receptor (endogenous compound) EMTREE DRUG INDEX TERMS androgen receptor (endogenous compound) antineoplastic agent (drug therapy) epidermal growth factor receptor 2 (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assessment of humans breast cancer (drug therapy, diagnosis, drug therapy) cancer prognosis estrogen receptor prognostic index EMTREE MEDICAL INDEX TERMS article cancer grading cancer hormone therapy cancer survival clinical decision making clinical effectiveness disease specific survival human human tissue immunohistochemistry instrument validation lymph node metastasis major clinical study priority journal protein expression tumor volume CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Clinical and Experimental Biochemistry (29) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013556961 MEDLINE PMID 23709174 (http://www.ncbi.nlm.nih.gov/pubmed/23709174) PUI L369739195 DOI 10.1093/annonc/mdt183 FULL TEXT LINK http://dx.doi.org/10.1093/annonc/mdt183 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 228 TITLE Optimizing the fascial closure: an analysis of 1261 abdominally based free flap reconstructions AUTHOR NAMES Cleveland E.C. Fischer J.P. Nelson J.A. Sieber B. Low D.W. Kovach S.J. Wu L.C. Serletti J.M. AUTHOR ADDRESSES (Cleveland E.C.; Fischer J.P.; Nelson J.A.; Sieber B.; Low D.W.; Kovach S.J.; Wu L.C.; Serletti J.M.) Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA SOURCE Annals of plastic surgery (2013) 71:3 (255-260). Date of Publication: 1 Sep 2013 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Donor-site morbidity continues to be a significant complication in patients undergoing abdominally based breast reconstruction. The purposes of our study were to critically examine abdominal donor-site morbidity and to present our algorithm for optimizing donor site closure to reduce these complications.METHODS: We performed a retrospective cohort study examining all patients undergoing abdominally based free tissue transfer for breast reconstruction from 2005 to 2011 at our institution. Data were analyzed for overall donor site morbidity, as defined by hernia/bulge or reoperation for debridement and/or mesh removal and for hernia/bulge alone.RESULTS: A total of 812 patients underwent 1261 free tissue transfers. Fifty-three patients (6.5%) experienced donor-site morbidity, including 27 hernias/bulges (3.3%). No significant difference in overall abdominal morbidity was found between unilateral and bilateral reconstructions (P = 0.39) or the use of muscle in the flap (P = 0.11 unilateral msfTRAM, P = 0.76 bilateral). Prior lower abdominal surgery was associated with higher rates of donor-site morbidity (P = 0.04); hypertension (P = 0.012) and multiple medical comorbidities (P < 0.001) were also significantly more common in these patients. Obesity was the only patient characteristic associated with higher rates of hernia/bulge (P = 0.04). Delayed abdominal would healing was associated with hernia/bulge (P < 0.001); these patients were significantly more likely to develop this complication (odds ratio = 6.3, P < 0.001).CONCLUSIONS: Particular attention must be provided to donor-site closure in obese patients and those with hypertension and multiple medical comorbidities. Low rates of abdominal wall morbidity result from meticulous fascial reconstruction and reinforcement and careful attention to tension-free soft tissue closure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) free tissue graft procedures surgery wound closure EMTREE MEDICAL INDEX TERMS algorithm breast reconstruction decision support system devices evaluation study fascia female human middle aged multivariate analysis outcome assessment postoperative complication (prevention) reoperation retrospective study statistical model surgical mesh LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23945529 (http://www.ncbi.nlm.nih.gov/pubmed/23945529) PUI L603120427 DOI 10.1097/SAP.0b013e318286380e FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e318286380e COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 229 TITLE Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial. AUTHOR NAMES Lam W.W. Chan M. Or A. Kwong A. Suen D. Fielding R. AUTHOR ADDRESSES (Lam W.W., wwtlam@hku.hk) Centre for Psycho-Oncological Research and Training, Department of Community Medicine and Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Rd, Pokfulam, Hong Kong; Special Administrative Region, People's Republic of China. (Chan M.; Or A.; Kwong A.; Suen D.; Fielding R.) CORRESPONDENCE ADDRESS W.W. Lam, Centre for Psycho-Oncological Research and Training, Department of Community Medicine and Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Rd, Pokfulam, Hong Kong; Special Administrative Region, People's Republic of China. Email: wwtlam@hku.hk SOURCE Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2013) 31:23 (2879-2885). Date of Publication: 10 Aug 2013 ISSN 1527-7755 (electronic) ABSTRACT Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT). Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression. The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001). This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision making decision support system patient education EMTREE MEDICAL INDEX TERMS article cancer staging controlled clinical trial controlled study female human methodology middle aged multicenter study pathology patient satisfaction psychological aspect questionnaire randomized controlled trial treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23835709 (http://www.ncbi.nlm.nih.gov/pubmed/23835709) PUI L563003962 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 230 TITLE Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial AUTHOR NAMES Lam W.W. Chan M. Or A. Kwong A. Suen D. Fielding R. AUTHOR ADDRESSES (Lam W.W.; Chan M.; Or A.; Kwong A.; Suen D.; Fielding R.) Centre for Psycho-Oncological Research and Training, Department of Community Medicine and Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Rd, Pokfulam, Hong Kong; Special Administrative Region, People's Republic of China. wwtlam@hku.hk SOURCE Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2013) 31:23 (2879-2885). Date of Publication: 10 Aug 2013 ISSN 1527-7755 (electronic) ABSTRACT PURPOSE: Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT).PATIENTS AND METHODS: Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression.RESULTS: The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001).CONCLUSION: This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making decision support system procedures EMTREE MEDICAL INDEX TERMS breast tumor (surgery) cancer staging clinical trial controlled study female human middle aged multicenter study pathology patient education patient satisfaction psychology questionnaire randomized controlled trial treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23835709 (http://www.ncbi.nlm.nih.gov/pubmed/23835709) PUI L603117557 DOI 10.1200/JCO.2012.45.1856 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2012.45.1856 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 231 TITLE Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool AUTHOR NAMES Rupert D.J. Squiers L.B. Renaud J.M. Whitehead N.S. Osborn R.J. Furberg R.D. Squire C.M. Tzeng J.P. AUTHOR ADDRESSES (Rupert D.J., drupert@rti.org; Squiers L.B.; Squire C.M.) Health Communication Program, RTI International, Research Triangle Park, NC, United States. (Renaud J.M.; Tzeng J.P.) Community Health Promotion Research Program, RTI International, Research Triangle Park, NC, United States. (Whitehead N.S.) Statistics and Epidemiology, RTI International, Atlanta, GA, United States. (Osborn R.J.) Research Computing Division, RTI International, Research Triangle Park, NC, United States. (Furberg R.D.) Center for the Advancement of Health IT, RTI International, Research Triangle Park, NC, United States. CORRESPONDENCE ADDRESS D.J. Rupert, Health Communication Program, RTI International, Research Triangle Park, 3040 Cornwallis Road, NC 27709, United States. Email: drupert@rti.org SOURCE Patient Education and Counseling (2013) 92:2 (188-196). Date of Publication: August 2013 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: Women with hereditary breast and ovarian cancer syndrome (HBOC) face a higher risk of earlier, more aggressive cancer. Because of HBOC's rarity, screening is recommended only for women with strong cancer family histories. However, most patients do not have accurate history available and struggle to understand genetic concepts. Methods: Cancer in the Family, an online clinical decision support tool, calculated women's HBOC risk and promoted shared patient-provider decisions about screening. A pilot evaluation (N = 9 providers, n = 48 patients) assessed the tool's impact on knowledge, attitudes, and screening decisions. Patients used the tool before wellness exams and completed three surveys. Providers accessed the tool during exams, completed exam checklists, and completed four surveys. Results: Patients entered complete family histories (67%), calculated personal risk (96%), and shared risk printouts with providers (65%). HBOC knowledge increased dramatically for patients and providers, and many patients (75%) perceived tool results as valid. The tool prompted patient-provider discussions about HBOC risk and cancer family history (88%). Conclusions: The tool was effective in increasing knowledge, collecting family history, and sparking patient-provider discussions about HBOC screening. Practice implications: Interactive tools can effectively communicate personalized risk and promote shared decisions, but they are not a substitute for patient-provider discussions. © 2013 Elsevier Ireland Ltd. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer risk decision support system hereditary breast and ovarian cancer syndrome (diagnosis) interpersonal communication EMTREE MEDICAL INDEX TERMS adult article cancer patient cancer screening clinical article clinical examination computer interface correlation analysis family history female gene mutation genetic screening health care personnel health survey human mammography medical decision making online system Papanicolaou test patient attitude patient decision making patient referral pilot study priority journal risk assessment software tumor suppressor gene DEVICE TRADE NAMES BRCAPRO EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013453769 MEDLINE PMID 23664232 (http://www.ncbi.nlm.nih.gov/pubmed/23664232) PUI L52575167 DOI 10.1016/j.pec.2013.04.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2013.04.008 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 232 TITLE Pre-consultation educational group intervention to improve shared decision-making in postmastectomy breast reconstruction: Study protocol for a pilot randomized controlled trial AUTHOR NAMES Platt J. Baxter N. Jones J. Metcalfe K. Causarano N. Hofer S.O.P. O'Neill A. Cheng T. Starenkyj E. Zhong T. AUTHOR ADDRESSES (Platt J., jennica.platt@mail.utoronto.ca; Baxter N., baxtern@smh.ca; Jones J., jennifer.jones@uhn.ca; Metcalfe K., kelly.metcalfe@utoronto.ca; Causarano N., natalie.causarano@uhn.ca; Hofer S.O.P., Stefan.Hofer@uhn.ca; O'Neill A., Anne.ONeill@uhn.ca; Cheng T., Terry.Cheng@uhn.ca; Starenkyj E., elizabeth.starenkyj@uhn.ca; Zhong T., toni.zhong@uhn.ca) UHN Breast Restoration Program, Division of Plastic and Reconstructive Surgery, 8N 871, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. CORRESPONDENCE ADDRESS T. Zhong, UHN Breast Restoration Program, Division of Plastic and Reconstructive Surgery, 8N 871, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. Email: toni.zhong@uhn.ca SOURCE Trials (2013) 14:1 Article Number: 199. Date of Publication: 6 Jul 2013 ISSN 1745-6215 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: The Pre-Consultation Educational Group Intervention pilot study seeks to assess the feasibility and inform the optimal design for a definitive randomized controlled trial that aims to improve the quality of decision-making in postmastectomy breast reconstruction patients.Methods/design: This is a mixed-methods pilot feasibility randomized controlled trial that will follow a single-center, 1:1 allocation, two-arm parallel group superiority design.Setting: The University Health Network, a tertiary care cancer center in Toronto, Canada.Participants: Adult women referred to one of three plastic and reconstructive surgeons for delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction.Intervention: We designed a multi-disciplinary educational group workshop that incorporates the key components of shared decision-making, decision-support, and psychosocial support for cancer survivors prior to the initial surgical consult. The intervention consists of didactic lectures by a plastic surgeon and nurse specialist on breast reconstruction choices, pre- and postoperative care; a value-clarification exercise led by a social worker; and discussions with a breast reconstruction patient.Control: Usual care includes access to an informational booklet, website, and patient volunteer if desired.Outcomes: Expected pilot outcomes include feasibility, recruitment, and retention targets. Acceptability of intervention and full trial outcomes will be established through qualitative interviews. Trial outcomes will include decision-quality measures, patient-reported outcomes, and service outcomes, and the treatment effect estimate and variability will be used to inform the sample size calculation for a full trial.Discussion: Our pilot study seeks to identify the (1) feasibility, acceptability, and design of a definitive RCT and (2) the optimal content and delivery of our proposed educational group intervention. Thirty patients have been recruited to date (8 April 2013), of whom 15 have been randomized to one of three decision support workshops. The trial will close as planned in May 2013. © 2013 Platt et al.; licensee BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction consultation mastectomy EMTREE MEDICAL INDEX TERMS adult article cancer survivor controlled study decision making female human interview medical specialist nurse outcome assessment pilot study plastic surgeon postoperative care randomized controlled trial social worker support group workshop EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01857882) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013443546 MEDLINE PMID 23829442 (http://www.ncbi.nlm.nih.gov/pubmed/23829442) PUI L52674647 DOI 10.1186/1745-6215-14-199 FULL TEXT LINK http://dx.doi.org/10.1186/1745-6215-14-199 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 233 TITLE A unified inference procedure for a class of measures to assess improvement in risk prediction systems with survival data AUTHOR NAMES Uno H. Tian L. Cai T. Kohane I.S. Wei L.J. AUTHOR ADDRESSES (Uno H., huno@jimmy.harvard.edu) Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA, United States. (Uno H., huno@jimmy.harvard.edu; Cai T.; Wei L.J.) Department of Biostatistics, Harvard University, Boston, MA, United States. (Tian L.) Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States. (Kohane I.S.) Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, United States. CORRESPONDENCE ADDRESS H. Uno, Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, United States. Email: huno@jimmy.harvard.edu SOURCE Statistics in Medicine (2013) 32:14 (2430-2442). Date of Publication: 30 Jun 2013 ISSN 0277-6715 1097-0258 (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Risk prediction procedures can be quite useful for the patient's treatment selection, prevention strategy, or disease management in evidence-based medicine. Often, potentially important new predictors are available in addition to the conventional markers. The question is how to quantify the improvement from the new markers for prediction of the patient's risk in order to aid cost-benefit decisions. The standard method, using the area under the receiver operating characteristic curve, to measure the added value may not be sensitive enough to capture incremental improvements from the new markers. Recently, some novel alternatives to area under the receiver operating characteristic curve, such as integrated discrimination improvement and net reclassification improvement, were proposed. In this paper, we consider a class of measures for evaluating the incremental values of new markers, which includes the preceding two as special cases. We present a unified procedure for making inferences about measures in the class with censored event time data. The large sample properties of our procedures are theoretically justified. We illustrate the new proposal with data from a cancer study to evaluate a new gene score for prediction of the patient's survival. © 2012 John Wiley & Sons, Ltd. EMTREE DRUG INDEX TERMS estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) evidence based medicine prediction risk assessment EMTREE MEDICAL INDEX TERMS adult article breast cancer (radiotherapy, surgery) cancer radiotherapy cancer surgery controlled study cost benefit analysis female follow up hormonal therapy human internal consistency Kaplan Meier method kernel method major clinical study mastectomy mathematical analysis mathematical model partial mastectomy probability receiver operating characteristic retrospective study simulation EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013360297 MEDLINE PMID 23037800 (http://www.ncbi.nlm.nih.gov/pubmed/23037800) PUI L52248405 DOI 10.1002/sim.5647 FULL TEXT LINK http://dx.doi.org/10.1002/sim.5647 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 234 TITLE Intentions for bilateral mastectomy among newly diagnosed breast cancer patients AUTHOR NAMES King L. O'Neill S.C. Spellman E. Peshkin B.N. Valdimarsdottir H. Willey S. Leventhal K.G. Demarco T. Nusbaum R. Feldman E. Jandorf L. Schwartz M.D. AUTHOR ADDRESSES (King L.; O'Neill S.C., sco4@georgetown.edu; Spellman E.; Peshkin B.N.; Leventhal K.G.; Demarco T.; Nusbaum R.; Schwartz M.D.) Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Washington, DC 20007, United States. (Valdimarsdottir H.; Jandorf L.) Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, United States. (Willey S.; Feldman E.) Department of Surgery, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States. CORRESPONDENCE ADDRESS S.C. O'Neill, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Washington, DC 20007, United States. Email: sco4@georgetown.edu SOURCE Journal of Surgical Oncology (2013) 107:7 (772-776). Date of Publication: June 2013 ISSN 0022-4790 1096-9098 (electronic) BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT Background Recent trends suggest that bilateral mastectomy (BM) is on the rise among women diagnosed with unilateral breast cancer. Few studies have investigated the factors associated with the decision to have more aggressive surgery among young, high risk patients. Methods As part of a larger study, 284 women aged 50 and under completed an initial survey within 6 weeks of a breast cancer diagnosis. We assessed sociodemographics, medical and family history variables, treatment recommendations, preferences and concerns, distress, perceived risk, knowledge, and neuroticism. We used multiple regression with backward entry to assess the relationship between these variables and our outcomes of decisional conflict and intentions for BM. Results Higher decisional conflict was associated with being less educated, unmarried, more anxious and less likely to have received a surgical recommendation. Preference for BM was associated with higher neuroticism, perceived risk for contralateral breast cancer, pre-testing risk of carrying a BRCA1/2 mutation, having received either a surgical recommendation (vs. no recommendation), and lower preference for lumpectomy. Conclusions For younger women, a surgical recommendation is associated with lower decisional conflict and stronger intention for BM. Results highlight the importance of effective risk communication and decision support between a woman and her surgeon. © 2012 Wiley Periodicals, Inc. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer patient mastectomy EMTREE MEDICAL INDEX TERMS adult article attitude to health cancer risk conflict decision making distress syndrome female gene mutation human major clinical study neurosis outcome assessment partial mastectomy priority journal risk assessment scoring system EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013338200 MEDLINE PMID 23280632 (http://www.ncbi.nlm.nih.gov/pubmed/23280632) PUI L52375165 DOI 10.1002/jso.23307 FULL TEXT LINK http://dx.doi.org/10.1002/jso.23307 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 235 TITLE Usability of a family health history and clinical decision support tool for patients and primary care providers AUTHOR NAMES Wu R.R. Himmel T. Powell K. Hauser E. Agbaje A.B. Henrich V. Ginsburg G.S. Orlando L.A. AUTHOR ADDRESSES (Wu R.R.; Hauser E.) VA Healthcare System, Durham, United States. (Wu R.R.; Ginsburg G.S.; Orlando L.A.) Duke University Health System, Durham, United States. (Himmel T.; Powell K.; Hauser E.; Henrich V.; Ginsburg G.S.) Duke University, Durham, United States. (Agbaje A.B.) Cone Health System, Greensboro, United States. CORRESPONDENCE ADDRESS R.R. Wu, VA Healthcare System, Durham, United States. SOURCE Journal of General Internal Medicine (2013) 28 SUPPL. 1 (S233). Date of Publication: June 2013 CONFERENCE NAME 36th Annual Meeting of the Society of General Internal Medicine, SGIM 2013 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2013-04-24 to 2013-04-27 ISSN 0884-8734 BOOK PUBLISHER Springer New York ABSTRACT BACKGROUND: Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree©, with embedded education for patients and providers on the collection (particularly how to collect from relatives) and importance of FHH, as well as decision support for breast cancer, colon cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. To evaluate the impact of the tool on patients, providers, clinic workflow, and patient care we integrated it into real world clinics and for this abstract we report on the usability of MeTree© for patients and providers. METHODS: All non-adopted adult English speaking patients with an upcoming routine appointment with their provider at 2 primary care clinics with 14 physicians in the Cone Health System were invited to participate by completing MeTree some time prior to their appointment. Patients and physicians completed surveys on their experience, patients after their appointment and at 3 and 12 months post-visit, physicians after 3 months of integration. RESULTS: Total patient enrollment was 1,184. Average time to complete MeTree was 27 min. Patients found MeTree: easy to use (93 %), easy to understand (97 %), useful (98 %), raised their awareness of disease risk (81 %), and changed how they think about their health (82 %). Of the 26 % (n=311) asking for assistance to complete MeTree, age (mean 65 sd 9.4 vs. 57 sd 11.7, p-value<0.00) and large pedigree size (24.5 sd 9.81 vs. 22.3 sd 8.41, p-value<0.00) were the only significant factors. 77 % (239) of those requiring assistance were over the age of 60. Patients learned: more relatives had diseases than they realized (20 %), relatives' diseases were more severe (11 %), relatives had diseases they did not know about (39 %), they were mistaken about what diseases some relatives had (18 %), and learned how old relatives were when they got a disease (39 %). Providers (n=14) found MeTree: improved their practice (87 %), improved their understanding of FHH (63 %), made practice easier (75 %), and worthy of recommending to their peers (93 %). CONCLUSIONS: Our study shows that FHH collection can be a positive experience for patients and providers and can be implemented without disruption to workflow. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system family health human internal medicine patient primary medical care society EMTREE MEDICAL INDEX TERMS adult breast cancer colon cancer diseases education female health health care hereditary tumor hospital ovary cancer patient care pedigree physician risk speech statistical significance thrombosis workflow LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71293137 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 236 TITLE A peer-led decision support intervention improves decision outcomes in black women with breast cancer AUTHOR NAMES Sheppard V.B. Wallington S.F. Willey S.C. Hampton R.M. Lucas W. Jennings Y. Horton S. Muzeck N. Cocilovo C. Isaacs C. AUTHOR ADDRESSES (Sheppard V.B.; Wallington S.F.; Willey S.C.; Hampton R.M.; Lucas W.; Jennings Y.; Horton S.; Muzeck N.; Cocilovo C.; Isaacs C.) Georgetown University Medical Center, Washington, DC, 20007, USA. vls3@georgetown.edu SOURCE Journal of cancer education : the official journal of the American Association for Cancer Education (2013) 28:2 (262-269). Date of Publication: 1 Jun 2013 ISSN 1543-0154 (electronic) ABSTRACT Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model-TALK Back!(©) A follow-up assessment assessed participants' acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p=  .000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making ethnology patient care peer group psychology social support EMTREE MEDICAL INDEX TERMS adult African American aged behavior breast tumor (therapy) doctor patient relation female follow up human middle aged patient attitude self concept United States very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23576067 (http://www.ncbi.nlm.nih.gov/pubmed/23576067) PUI L603060718 DOI 10.1007/s13187-013-0459-z FULL TEXT LINK http://dx.doi.org/10.1007/s13187-013-0459-z COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 237 TITLE Deficient cancer screening discussions: Results from a national survey AUTHOR NAMES Hoffman R. Elmore J.G. Fairfield K. Gerstein B. Pignone M. Levin C.A. AUTHOR ADDRESSES (Hoffman R.) Albuquerque VA Medical Center, Albuquerque, United States. (Elmore J.G.) University of Washington, Seattle, United States. (Fairfield K.) Maine Medical Center, Portland, United States. (Gerstein B.; Levin C.A.) Informed Medical Decisions Foundation, Boston, United States. (Pignone M.) University of North Carolina, Chapel Hill, United States. CORRESPONDENCE ADDRESS R. Hoffman, Albuquerque VA Medical Center, Albuquerque, United States. SOURCE Journal of General Internal Medicine (2013) 28 SUPPL. 1 (S58). Date of Publication: June 2013 CONFERENCE NAME 36th Annual Meeting of the Society of General Internal Medicine, SGIM 2013 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2013-04-24 to 2013-04-27 ISSN 0884-8734 BOOK PUBLISHER Springer New York ABSTRACT BACKGROUND: Cancer screening decisions are considered preferencesensitive, and providers are expected to help patients achieve informed decisions. We evaluated the content, processes, and outcomes of cancer screening discussions. METHODS: The TRENDS study is an Internet-based survey of US adults aged ≥ 40 conducted in 2011. Respondents in this analysis reported discussing screening for breast (BrCa), colorectal (CRC), or prostate (PCa) cancer with a health care provider within the past 2 years. We queried respondents about the content of screening discussions (addressing pros and cons of screening), the decision-making process (did providers ask respondents whether they wanted a test, did providers explain that respondents could choose whether to have a test, did providers express opinions and recommend screening, who made the final decision), and discussion outcomes (testing decisions and whether respondents would make the same decision again). We analyzed data with descriptive statistics and chi-square tests. RESULTS: Overall, 1382 respondents discussed cancer screening. The mean (SD) age was 59.9 (10.8), 74 % were non-Hispanic whites, 33 % were college graduates, and 46 % reported excellent/very good health. Nearly all discussions addressed the pros of screening, but only one-third addressed cons. Respondents reported that providers explained that they could choose whether to be screened in 67 % of the discussions, and were asked whether they wanted to be screened in 56 % of discussions. In 73 % of discussions, respondents reported that providers recommending testing. About 60 % reported that the decision was mainly their own, while 33 % made the decision together with their provider, and 7 % reported that the provider mainly made the decision. Only 8 % of discussions presented pros and cons of screening, explained that respondents had a choice whether to be screened, and asked respondents for their input. Overall, the majority of respondents underwent screening (77 %) and would definitely make the same decision again (69 %). The Table shows selected results by type of cancer screening discussion. CONCLUSIONS: Cancer screening discussions often failed to provide balanced information by not addressing the cons of screening. Respondents did not routinely participate in shared decision-making, particularly for breast cancer screening. Supporting shared decision-making could improve the quality of cancer screening decisions and increase patient satisfaction. Cancer screening discussions: content, processes, and outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening internal medicine society EMTREE MEDICAL INDEX TERMS adult breast breast cancer chi square test decision making graduate health health care personnel Hispanic human Internet male patient patient satisfaction prostate cancer screening statistics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71292724 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 238 TITLE A peer-led decision support intervention improves decision outcomes in black women with breast cancer. AUTHOR NAMES Sheppard V.B. Wallington S.F. Willey S.C. Hampton R.M. Lucas W. Jennings Y. Horton S. Muzeck N. Cocilovo C. Isaacs C. AUTHOR ADDRESSES (Sheppard V.B., vls3@georgetown.edu) Georgetown University Medical Center, Washington, DC, 20007, USA. (Wallington S.F.; Willey S.C.; Hampton R.M.; Lucas W.; Jennings Y.; Horton S.; Muzeck N.; Cocilovo C.; Isaacs C.) CORRESPONDENCE ADDRESS V.B. Sheppard, Georgetown University Medical Center, Washington, DC, 20007, USA. Email: vls3@georgetown.edu SOURCE Journal of cancer education : the official journal of the American Association for Cancer Education (2013) 28:2 (262-269). Date of Publication: Jun 2013 ISSN 1543-0154 (electronic) ABSTRACT Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model-TALK Back!(©) A follow-up assessment assessed participants' acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p= .000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) African American breast tumor (therapy) decision making patient care peer group social support EMTREE MEDICAL INDEX TERMS adult aged article behavior doctor patient relation ethnology female follow up human middle aged patient attitude psychological aspect self concept United States very elderly LANGUAGE OF ARTICLE English MEDLINE PMID 23576067 (http://www.ncbi.nlm.nih.gov/pubmed/23576067) PUI L563014610 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 239 TITLE A before/after trial of a decision aid on mammography screening for women aged 75 and older AUTHOR NAMES Schonberg M.A. Hamel M.B. Davis R.B. Marcantonio E.R. AUTHOR ADDRESSES (Schonberg M.A.; Hamel M.B.; Davis R.B.; Marcantonio E.R.) Beth Israel Deaconess Medical Center, Boston, United States. CORRESPONDENCE ADDRESS M.A. Schonberg, Beth Israel Deaconess Medical Center, Boston, United States. SOURCE Journal of General Internal Medicine (2013) 28 SUPPL. 1 (S3-S4). Date of Publication: June 2013 CONFERENCE NAME 36th Annual Meeting of the Society of General Internal Medicine, SGIM 2013 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2013-04-24 to 2013-04-27 ISSN 0884-8734 BOOK PUBLISHER Springer New York ABSTRACT BACKGROUND: Guidelines state there is insufficient evidence to recommend mammography screening for women aged >75 years. Instead, they encourage clinicians to discuss the potential benefits and risks of screening and engage older women in shared decision-making. We aimed to design and evaluate a decision aid (DA) for women >75 years to inform their decision-making around mammography screening. METHODS: We designed the DA based on international standards and included data from medical literature review. An expert panel reviewed iterative versions of the DA and it was then reviewed for acceptability by 15 patients and 5 of their primary care physicians (PCPs). The 10-page DA (written at a 6th grade reading level) includes information on breast cancer risk, life expectancy, competing mortality risks, likely outcomes if screened or not screened over 5 years, and a values clarification exercise. We evaluated the DA in a before/after trial at a large academic primary care practice in Boston. Eligible women were >75 years, spoke and read English fluently, had not had a mammogram in the past 9 months but were screened in the past 3 years, did not have a history of invasive or non-invasive breast cancer or dementia, and were scheduled for a routine visit with their PCP within 8 weeks. Participants came early to their PCP appointment to complete a “before” survey and to read the DA. After the visit, they completed an “after” survey. The surveys included 10 knowledge questions, the 16-item decisional conflict scale (DCS, 0-100, lower scores = less conflict), and a question that assessed screening intentions. Participants were followed by medical record for up to 1 year to examine whether there was a note documenting a discussion of the pros/cons of screening and to abstract receipt of mammography. We used the signed rank test and McNemar's test to compare before/ after responses. We also asked PCPs to complete a survey about using the DA in their practice. RESULTS: Forty-nine before/after trial participants (from 26 PCPs) had median age of 79 years; 70 % were Non-Hispanic white; 63 % had attended some college; and 24 % had <7 year life expectancy. Comparison of “after” to “before” survey results found: 1) participants answered on average 1 more question correct (interquartile range 0-2) on the 10 item index from 6 to 7 questions correct, p<0.001; 2) decisional conflict declined by 4.8 points (range -10.2 to +4.7 points, mean DCS scores before = 20.1, p=0.03); and 3) fewer participants intended to be screened (59 % compared to 82 % before, p=0.01). In the following 6 months, 61 % of participants had a PCP note documenting a discussion of the pros/cons of screening compared to 10 % in the previous 5 years, p<0.001. While 86 % had been screened within 2 years before participating only 61 % were screened within 1 year after, p<0.001 (a similar decline was found among women with <7 year life expectancy). Overall, 94 % reported that they would recommend the DA, 94 % found it helpful, and 78 % found the amount of information just right. PCPs (17/26) reported that using the DA would result in their patients making more informed (74 %) and value laden (79 %) decisions. CONCLUSIONS: We developed a DA for women aged >75 years contemplating mammography screening. Our before/after trial demonstrates that this DA allows women to make more informed, preferencesensitive decisions around mammography screening. Next, we plan to test the effectiveness of the DA in a large randomized control trial. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female human internal medicine mammography screening society EMTREE MEDICAL INDEX TERMS breast cancer cancer risk college decision making dementia exercise general practitioner Hispanic life expectancy McNemar test medical literature medical record mortality patient primary medical care reading risk United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71292595 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 240 TITLE Which sentinel lymph-node (SLN) positive breast cancer patient needs an axillary lymph-node dissection (ALND) - ACOSOG Z0011 results and beyond AUTHOR NAMES Gatzemeier W. Bruce Mann G. AUTHOR ADDRESSES (Gatzemeier W., wolfgang.gatzemeier@humanitas.it) Humanitas Clinical Institute, Breast Unit, Via Manzoni 56, Milan, Italy. (Bruce Mann G.) The Breast Service, The Royal Melbourne and Royal Women's Hospital, Victoria, Australia. CORRESPONDENCE ADDRESS W. Gatzemeier, Humanitas Clinical Institute, Breast Unit, Via Manzoni 56, Milan, Italy. Email: wolfgang.gatzemeier@humanitas.it SOURCE Breast (2013) 22:3 (211-216). Date of Publication: June 2013 ISSN 0960-9776 1532-3080 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Axillary management has evolved from routine axillary lymph node dissection (ALND) for most patients to a selective approach based on the assessment of the sentinel node (SN). Validation of this approach for staging the axilla is based on observational studies and multiple randomized trials with near general consensus that in case of negative SN completion ALND is not required and if the SN contained metastatic disease, a completion ALND is recommended.Multiple observations have challenged the need for routine completion ALND and growing evidence from institutional series have indicated that selective omission of ALND in patients with positive SN was safe. Unfortunately, the main randomized study addressing the question of the need for a completion axillary dissection closed early having failed to meet its accrual targets. The presentation and publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 study has provoked controversy around the world regarding the extent to which this is a practice-changing study. The aim of this review was to critically re-appraise Z0011 results and assess available evidence which should be used to support the decision of which SN positive breast cancer patient needs an ALND. © 2013 Elsevier Ltd. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axillary lymph node breast cancer (drug therapy, drug therapy, radiotherapy) lymph node dissection sentinel lymph node metastasis EMTREE MEDICAL INDEX TERMS cancer prognosis cancer radiotherapy cancer staging disease free survival human mastectomy micrometastasis overall survival partial body radiation partial mastectomy phase 3 clinical trial (topic) priority journal review sentinel lymph node biopsy survival rate tumor recurrence tumor volume whole breast irradiation EMBASE CLASSIFICATIONS Cancer (16) Hematology (25) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013289662 MEDLINE PMID 23478200 (http://www.ncbi.nlm.nih.gov/pubmed/23478200) PUI L52476633 DOI 10.1016/j.breast.2013.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2013.02.001 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 241 TITLE 13th St. Gallen international breast cancer conference 2013: Primary therapy of early breast cancer evidence, controversies, consensus - Opinion of a German team of experts (Zurich 2013) AUTHOR NAMES Untch M. Gerber B. Harbeck N. Jackisch C. Marschner N. Möbus V. Von Minckwitz G. Loibl S. Beckmann M.W. Blohmer J.-U. Costa S.-D. Decker T. Diel I. Dimpfl T. Eiermann W. Fehm T. Friese K. Jänicke F. Janni W. Jonat W. Kiechle M. Köhler U. Lück H.-J. Maass N. Possinger K. Rody A. Scharl A. Schneeweiss A. Thomssen C. Wallwiener D. Welt A. AUTHOR ADDRESSES (Untch M., Michael.untch@helios-kliniken.de) Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany. (Gerber B.) Universitätsfrauenklinik Rostock, Germany. (Harbeck N.) Brustzentrum, Frauenklinik der Universität München (LMU), München, Germany. (Jackisch C.) Klinik für Gynäkologie und Geburtshilfe, Klinikum Offenbach, Germany. (Marschner N.) Gemeinschaftspraxis für Interdisziplinäre Onkologie und Hämatologie, Freiburg I.Br., Germany. (Möbus V.) Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt-Höchst, Frankfurt/M., Germany. (Von Minckwitz G.; Loibl S.) German Breast Group, Neu-Isenburg, Germany. (Von Minckwitz G.) Universitäts-Frauenklinik, Frankfurt/M., Germany. (Von Minckwitz G.) Senologische Onkologie, Düsseldorf, Germany. (Beckmann M.W.) Universitätsfrauenklinik Erlangen, Germany. (Blohmer J.-U.) St. Gertrauden Krankenhaus, Berlin, Germany. (Costa S.-D.) Universitätsfrauenklinik Magdeburg, Germany. (Decker T.) Gemeinschaftspraxis Onkologie, Ravensburg, Germany. (Diel I.) Gemeinschaftspraxis Gynäkologie und Geburtshilfe, Mannheim, Germany. (Dimpfl T.) Klinik für Frauenheilkunde und Geburtshilfe, Kassel, Germany. (Eiermann W.) Interdisziplinäres Onkologisches Zentrum, München, Germany. (Fehm T.) Universitätsfrauenklinik Düsseldorf, Germany. (Friese K.) Universitätsfrauenklinik München, Germany. (Jänicke F.) Klinik und Poliklinik für Gynäkologie des Universitä tsklinikums Hamburg-Eppendorf, Germany. (Janni W.) Universitätsfrauenklinik Ulm, Germany. (Jonat W.) Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Um Schleswig-Holstein, Campus Kiel, Germany. (Kiechle M.) Frauenklinik Rechts der Isar der Technischen Universität München, Germany. (Köhler U.) Klinik für Gynäkologie und Geburtshilfe Am Klinikum St. Georg, Leipzig, Germany. (Lück H.-J.) Gynäkologisch-onkologische Praxis, Hannover, Germany. (Maass N.) Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, Germany. (Possinger K.) Universitätsklinikum Charité Berlin, Germany. (Rody A.) Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany. (Scharl A.) Frauenklinik, Klinikum St. Marien, Ambarg, Germany. (Schneeweiss A.) Nationales Centrum für Tumorerkrankungen (NCTund Universitä tsfrauenklinik Heidelberg, Germany. (Thomssen C.) Universitätsklinik und Poliklinik für Gynäkologie, Halle (Saale), Germany. (Wallwiener D.) Universitätsfrauenklinik Tübingen, Germany. (Welt A.) Westdeutsches Tumorzentrum des Universitätsklinikums Essen, Germany. CORRESPONDENCE ADDRESS M. Untch, Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany. Email: Michael.untch@helios-kliniken.de SOURCE Breast Care (2013) 8:3 (221-229). Date of Publication: June 2013 ISSN 1661-3791 1661-3805 (electronic) BOOK PUBLISHER S. Karger AG, Allschwilerstrasse 10, P.O. Box, Basel, Switzerland. ABSTRACT The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radio-therapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed. © 2013 S. Karger GmbH, Freiburg. EMTREE DRUG INDEX TERMS anthracycline (drug therapy) bisphosphonic acid derivative (drug therapy) tamoxifen (drug therapy) taxane derivative (drug therapy) trastuzumab (drug therapy) zoledronic acid (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, surgery, therapy) cancer therapy EMTREE MEDICAL INDEX TERMS article breast calcification cancer adjuvant therapy cancer chemotherapy cancer hormone therapy cancer recurrence cancer surgery clinical practice consensus disease free survival dose densification early cancer estrogen receptor positive breast cancer family history Germany health care quality high risk population human inflammatory breast cancer intraductal carcinoma irradiation long term survival lymph node dissection lymphocytic infiltration molecular diagnostics molecularly targeted therapy nuclear magnetic resonance imaging osteoporosis ovarian preservation ovary function partial mastectomy phase 3 clinical trial (topic) postmenopause priority journal recurrence risk sentinel lymph node Switzerland systemic therapy treatment duration treatment indication triple negative breast cancer CAS REGISTRY NUMBERS tamoxifen (10540-29-1) trastuzumab (180288-69-1) zoledronic acid (118072-93-8, 131654-46-1, 165800-06-6, 165800-07-7) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2013470805 PUI L369419868 DOI 10.1159/000351692 FULL TEXT LINK http://dx.doi.org/10.1159/000351692 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 242 TITLE Clinical impact of an online tool to guide choice of therapy (Tx) for patients (Pts) with advanced renal cell carcinoma (RCC) AUTHOR NAMES Quill T.A. Rini B.I. Jonasch E. Bowser A. Mortimer J.A. Motzer R.J. AUTHOR ADDRESSES (Quill T.A.; Rini B.I.; Jonasch E.; Bowser A.; Mortimer J.A.; Motzer R.J.) Clinical Care Options, LLC, Reston, VA; Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; The University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY CORRESPONDENCE ADDRESS T.A. Quill, SOURCE Journal of Clinical Oncology (2013) 31:15 SUPPL. 1. Date of Publication: 20 May 2013 CONFERENCE NAME 2013 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2013-05-31 to 2013-06-04 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Clinical practice guidelines outline multiple treatment options for pts with advanced RCC, but provide little to no guidance on the best Tx for an individual pt. We have previously reported that online interactive decision support tools may help practicing community oncologists identify optimal treatment approaches in breast and lung cancers and CML (ASCO 2011 [abstr 6063]; ASTRO 2012 [abstr 162]; ASH 2012 [abstr 4279]). Here, we assess the impact of a tool on the decisions of clinicians treating pts with advanced RCC. Methods: An online tool was developed based on asurvey of experts who were asked what Tx they would choose for 76 pt case variations. Experts considered patient- and tumor-specific characteristics including histology (clear cell vs nonclear cell), extent of metastases, previous systemic therapy received, MSKCC risk status (good/intermediate vs poor), and ECOG performance score (0 vs 1 vs 2). The tool was built based on their responses and posted online July 12, 2012. After tool users input specific pt characteristics and indicate their intended Tx plan, a table of expert Tx choices are displayed for that pt scenario. To determine the impact of viewing the expert choices, users are then asked if the expert feedback has confirmed or changed their original Tx plan. Results: Three experts completed the survey. Key factors in the experts' Tx choices were MSKCC risk status for first-line therapy and previous systemic therapy. Preliminary data of 419 cases entered by participants in the online tool show that expert insight changed or confirmed Tx choice for 81% of participants (changed: 22%; confirmed: 59%). An analysis of expert vs user treatment selections in specific subpopulations will be presented. Conclusions: An online tool designed to provide customized, patient-specific expert advice may increase the number of clinicians who make optimal treatment decisions for patients with advanced RCC. Data indicate that the expert choices influenced clinicians' Tx decisions and, therefore, may facilitate improvements in pt care and outcomes. The tool was developed through an unrestricted educational grant from Pfizer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human kidney carcinoma oncology patient society therapy EMTREE MEDICAL INDEX TERMS breast community decision support system electrocorticography feedback system histology lung cancer metastasis neoplasm practice guideline risk systemic therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71101406 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 243 TITLE SPY-Q analysis toolkit values potentially predict mastectomy flap necrosis. AUTHOR NAMES Newman M.I. Jack M.C. Samson M.C. AUTHOR ADDRESSES (Newman M.I.) Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA. (Jack M.C.; Samson M.C.) CORRESPONDENCE ADDRESS M.I. Newman, Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA. Email: newmanm@ccf.org SOURCE Annals of plastic surgery (2013) 70:5 (595-598). Date of Publication: May 2013 ISSN 1536-3708 (electronic) ABSTRACT Previously, we and other investigators have reported the benefits of using SPY Intraoperative Perfusion Assessment System to assist in the prediction of mastectomy flap necrosis. To date, analysis of the SPY images has been subjective. However, the new SPY-Q postprocessing software allows for objective quantification of SPY images through the application of absolute and relative values of fluorescence intensity. This study seeks to determine the use of these objective, numerical data and their role in potentially predicting mastectomy flap necrosis. In a retrospective fashion, 20 SPY images from immediate breast reconstructions were randomly selected from a database of more than 100 images: 10 from breasts that developed flap necrosis and 10 from breasts that demonstrated adequate healing. Groups were matched for age, body mass index, and comorbidities. The points of necrosis and points of adequate healing were evaluated using the postprocessing software, and the groups were compared. The mean "relative" fluorescence of the necrosis and the adequate healing groups was 25.2% and 43.3%, respectively (P < 0.001). The mean absolute fluorescence of the 2 groups was 18.5 and 25.0, respectively (P = 0.07). These findings suggest that quantitative "relative" perfusion values as generated by the postprocessing software may augment clinical judgment of flap viability in an objective and reproducible fashion. EMTREE DRUG INDEX TERMS diagnostic agent fluorescent dye indocyanine green EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision support system fluorescence imaging image processing peroperative care postoperative complication (diagnosis) surgical flaps EMTREE MEDICAL INDEX TERMS article evaluation study female graft survival human mastectomy methodology middle aged necrosis (diagnosis, etiology) pathology retrospective study risk assessment software treatment outcome vascularization CAS REGISTRY NUMBERS indocyanine green (3599-32-4) LANGUAGE OF ARTICLE English MEDLINE PMID 23542838 (http://www.ncbi.nlm.nih.gov/pubmed/23542838) PUI L370092860 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 244 TITLE A retrospective analysis of patients with margin positive wide local excision for DCIS to evaluate predictors that aid the decision between re-excision of margins or completion mastectomy AUTHOR NAMES Mansfield L. King M. Ngu A. Wise M. Yiangou C. Agrawal A. AUTHOR ADDRESSES (Mansfield L.; King M.; Ngu A.; Wise M.; Yiangou C.; Agrawal A.) Queen Alexandra Hospital, Portsmouth, United Kingdom. CORRESPONDENCE ADDRESS L. Mansfield, Queen Alexandra Hospital, Portsmouth, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (519). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Selecting a treatment strategy following wide local excision (WLE) for DCIS with positive margins is challenging. This study sought to identify factors associated with residual disease, thus aiding the decision between margin re-excision and completion mastectomy. Method: A retrospective analysis of all patients with DCIS on WLE with positive margins (<1 mm), 1999-2012. Categorical data were analysed with Fisher's exact test. Results: Complete data was available for 80/108 patients. On further surgery (margins re-excision or mastectomy) 45 had residual disease. 42% of these had ≥2 positive margins (PM) compared to 14% for the 35 patients with no disease (p<0.01; sensitivity 75%, specificity 86%, PPV 79%). 52 patients had margin re-excision. Clearance was achieved in 40. 15% had ≥2 PM. This was in contrast to 58% for patients in whom clearance was not achieved (p < 0.01). 28 patients proceeded straight to mastectomy. Eight patients had no residual disease. 25% had ≥2 PM. Twenty patients had further disease of which 50% had ≥2 PM. This suggested a similar trend but did not reach statistical significance. 4 patients had a recurrence in the time period (2 treated with margin re-excision, 2 with completion mastectomy). Data were also analysed between groups for DCIS grade and a ratio of pathological:mammographic size. No associations were found. Conclusion: Two or more positive margins on WLE for DCIS is an indicator that there is residual DCIS within the breast and that oncological clearance is less likely to be achieved with a single margin reexcision. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery excision human intraductal carcinoma mastectomy patient wide excision EMTREE MEDICAL INDEX TERMS breast Fisher exact test minimal residual disease statistical significance surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050681 DOI 10.1016/j.ejso.2013.01.021 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.021 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 245 TITLE What is lacking in current decision aids on cancer screening? AUTHOR NAMES Jimbo M. Rana G.K. Hawley S. Holmes-Rovner M. Kelly-Blake K. Nease Jr. D.E. Ruffin IV M.T. AUTHOR ADDRESSES (Jimbo M., mjimbo@med.umich.edu) Department of Family Medicine and Urology, University of Michigan, Ann Arbor, MI, United States. (Rana G.K.) Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, United States. (Hawley S.) Department of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, United States. (Holmes-Rovner M.) Department of Medicine, Center for Ethics, Michigan State University College of Human Medicine, East Lansing, MI, United States. (Kelly-Blake K.) Center for Ethics and Humanities in the Life Sciences, Michigan State University College of Human Medicine, East Lansing, MI, United States. (Nease Jr. D.E.) Department of Family Medicine and Colorado Health Outcomes Program, University of Colorado at Denver, Aurora, CO, United States. (Jimbo M., mjimbo@med.umich.edu; Ruffin IV M.T.) Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104-1213, United States. CORRESPONDENCE ADDRESS M. Jimbo, Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104-1213, United States. Email: mjimbo@med.umich.edu SOURCE CA Cancer Journal for Clinicians (2013) 63:3 (193-214). Date of Publication: May-June 2013 ISSN 0007-9235 1542-4863 (electronic) BOOK PUBLISHER Wiley-Blackwell, 350 Main Street, Malden, United States. ABSTRACT Recent guidelines on cancer screening have provided not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to use, and how often to undergo screening. Decision aids could potentially lead to better shared decision-making regarding screening between the patient and the clinician. A total of 73 decision aids concerning screening for breast, cervical, colorectal, and prostate cancers were reviewed. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need of more research, and determine how the decision aids can be currently applied in the real-world setting. Most studies used sound study designs. Significant variation existed in the setting, theoretical framework, and measured outcomes. Just over one-third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted with regard to which patient attributes were measured as outcomes. Few studies actually measured shared decision-making. Little information was available regarding the feasibility and outcomes of integrating decision aids into practice. In this review, the implications for future research, as well as what clinicians can do now to incorporate decision aids into their practice, are discussed. Copyright © 2013 American Cancer Society, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening clinical decision making EMTREE MEDICAL INDEX TERMS breast cancer (diagnosis) cancer patient cancer research clinical practice colorectal cancer (diagnosis) conceptual framework feasibility study human outcome assessment practice guideline priority journal prostate cancer (diagnosis) questionnaire review uterine cervix cancer (diagnosis) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013293395 MEDLINE PMID 23504675 (http://www.ncbi.nlm.nih.gov/pubmed/23504675) PUI L368870016 DOI 10.3322/caac.21180 FULL TEXT LINK http://dx.doi.org/10.3322/caac.21180 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 246 TITLE Decision aids for patients facing a surgical treatment decision: A systematic review and meta-analysis AUTHOR NAMES Knops A.M. Legemate D.A. Goossens A. Bossuyt P.M.M. Ubbink D.T. AUTHOR ADDRESSES (Knops A.M.; Legemate D.A.; Ubbink D.T., d.ubbink@amc.nl) Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. (Knops A.M.; Goossens A.; Ubbink D.T., d.ubbink@amc.nl) Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands. (Bossuyt P.M.M.) Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS D.T. Ubbink, Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands. Email: d.ubbink@amc.nl SOURCE Annals of Surgery (2013) 257:5 (860-866). Date of Publication: May 2013 ISSN 0003-4932 1528-1140 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVE: To summarize the evidence available on the effects of decision aids in surgery. BACKGROUND: When consenting to treatment, few patients adequately understand their treatment options. To help patients make deliberate treatment choices, decision aids provide evidence-based information on the disease, treatment options, and their associated benefits and harms. Although decision aids are not designed to direct patients toward a particular treatment option, it is possible that their introduction will change the proportion of patients that opt for surgery. METHODS: We searched electronic databases for studies that evaluated a decision aid in patients offered both surgery and alternative treatment options, regarding the effect on the actual treatment choices made. In addition, we documented effects on knowledge, decisional conflict, anxiety, quality of life, patient involvement, satisfaction, mortality, morbidity, and costs. RESULTS: Seventeen studies were included. Overall, methodological study quality was good. Patients in the decision aid group less often chose to undergo invasive treatment [risk ratio = 0.80; 95% confidence interval, 0.67-0.95), had more knowledge about treatment options [mean difference = 8.99; 95% confidence interval, 3.20-14.78), and experienced less decisional conflict (mean difference = -5.04; 95% confidence interval, -7.10 to -2.99). Levels of anxiety and quality of life were similar. CONCLUSIONS: Offering a decision aid increases the number of patients who prefer conservative or less invasive treatment options. As decision aids improve patient knowledge and lower decisional conflict without raising anxiety levels, they have a place in surgery to help surgeons and patients achieve well-considered and shared treatment decisions. Copyright © 2013 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical decision making surgical patient EMTREE MEDICAL INDEX TERMS anxiety article bariatric surgery breast reconstruction confidence interval conservative treatment cost electronic medical record human lung transplantation mastectomy meta analysis morbidity mortality patient satisfaction priority journal prostatectomy quality of life risk spine surgery systematic review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013243969 MEDLINE PMID 23470574 (http://www.ncbi.nlm.nih.gov/pubmed/23470574) PUI L52474601 DOI 10.1097/SLA.0b013e3182864fd6 FULL TEXT LINK http://dx.doi.org/10.1097/SLA.0b013e3182864fd6 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 247 TITLE A classification system for fat necrosis in autologous breast reconstruction. AUTHOR NAMES Wagner I.J. Tong W.M. Halvorson E.G. AUTHOR ADDRESSES (Wagner I.J.) Division of Plastic Surgery, Department of Surgery, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA. (Tong W.M.; Halvorson E.G.) CORRESPONDENCE ADDRESS I.J. Wagner, Division of Plastic Surgery, Department of Surgery, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA. SOURCE Annals of plastic surgery (2013) 70:5 (553-556). Date of Publication: May 2013 ISSN 1536-3708 (electronic) ABSTRACT Fat necrosis (FN) is a common complication of autologous breast reconstruction, yet no classification system exists to describe it. We sought to develop and validate a tool for meaningful reporting, comparison of techniques, and treatment planning. Our hypothesis was that a valid classification system would demonstrate higher grades of FN for pedicled transverse rectus abdominus myocutaneous (pTRAM) flaps as compared to free flaps (FF). A classification system for FN was developed: grade I, radiologic evidence only; grade II, palpable but not visible FN; grade III, palpable and visible FN; and grade IV, symptomatic FN. For validation, we applied this system to patients who had undergone pTRAM flaps from 2002 to 2006 and FF from 2006 to 2010 at our institution. We performed 93 pTRAM flaps in 69 patients and 102 FF in 69 patients. One patient had grade I FN and was observed. Of the 29 patients with grade II FN, 48% were observed, 17% had biopsy, and 35% underwent debridement. Of the 9 patients with grade III FN, 11% underwent biopsy and 89% had debridement. All patients with grade IV FN underwent debridement. The distribution of FN differed between pTRAM and FF. The mean FN grade for patients undergoing pTRAM was 1.4 versus 0.4 for those undergoing FF (P < 0.05). Fat necrosis requiring reoperation was more frequent in the pTRAM group (23.7% vs 5.9%, P < 0.05). Our validation study confirmed that FN grade was associated with the need for surgery and was higher for pedicled flaps as compared to FFs. As it is similar to the Baker grading system for capsular contracture, this classification system is familiar to all plastic surgeons. It is simple, easy to remember, clinically oriented, and could be readily incorporated into outcome studies of autologous breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision support system fat necrosis (diagnosis, etiology, surgery) postoperative complication (diagnosis, etiology, surgery) EMTREE MEDICAL INDEX TERMS algorithm article classification debridement evaluation study female human methodology reoperation reproducibility retrospective study risk factor surgical flaps LANGUAGE OF ARTICLE English MEDLINE PMID 23542852 (http://www.ncbi.nlm.nih.gov/pubmed/23542852) PUI L370092873 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 248 TITLE A surgical decision support system (SDSS) to promote enhanced communication between low english proficiency (LEP), ethnically diverse breast cancer patients and their providers in an inner city hospital AUTHOR NAMES Dhage S. Castaneda M. Zeng X. Checka C. Joseph K.-A. Guth A. Bright K. AUTHOR ADDRESSES (Dhage S.; Castaneda M.; Zeng X.; Checka C.; Joseph K.-A.; Guth A.; Bright K.) NYUSOM, New York, United States. (Dhage S.; Castaneda M.; Zeng X.; Checka C.; Joseph K.-A.; Guth A.; Bright K.) Carleton University, Ottawa, Canada. CORRESPONDENCE ADDRESS S. Dhage, NYUSOM, New York, United States. SOURCE Annals of Surgical Oncology (2013) 20:2 SUPPL. 1 (36-37). Date of Publication: April 2013 CONFERENCE NAME 14th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2013-05-01 to 2013-05-05 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives : Ethnically diverse and LEP breast cancer patients are at a disadvantage in participating in shared decision making and informed treatment decisions due to language barriers and deficiencies in health literacy. Additional educational resources must be employed in those settings to support and enhance communication with those patients. An interactive surgical decision support system (SDSS) was created, by utilizing medical interpretation and computer-based animations to promote more effective and culturally competent communication among patients and their surgical providers. A pilot study was conducted at an inner city hospital to evaluate the effectiveness of the SDSS. Methods : Newly diagnosed breast cancer patients were identified as eligible for participation in the study by their surgeon at the Breast Care Clinic. The SDSS consisted of a 10-minute, one-on-one consultation between the patient and her surgical provider or a research coordinator in a private room with the additional support of trained medical interpreters in Chinese and Spanish, as needed. The SDSS was developed in collaboration with the IT department and consisted of computer-based animations and a companion script informed by guidelines from the American Society of American Oncology (ASCO). Assessments were conducted using a mixed-method interview guide at 4 points during surgical oncology visits-Q1-Q3 were pre-surgery-(pre-SDSS-Q1, post-SDSS-Q2, after signing consent-Q3, and post-surgery-Q4) and were guided by variables as outlined by the Health Belief Model and Theory of Planned Behaviour. Validated scales were used to assess preparation for decision-making, decision conflict, and satisfaction with the SDSS. Results : Data were collected from 70 patients, 39 patients (mean age, 49.4) completed all 4 questionnaires. Of these patients, 33.3% spoke Spanish, 25.6% spoke Mandarin, and 25.6% spoke English. 33.3% patients underwent a mastectomy and 66.7% patients underwent a lumpectomy. At Q3, 100% of the participants felt confident about their decision and prepared for their surgical procedure. At Q4, 100% of the patients were satisfied with the information they received regarding their surgery options. The conflict felt in making decisions was reduced from Q2 and Q3. 94.9% did not want to change their decision at Q3. The difference in the decision conflict scale between Q3 (pre-surgery) and Q4 (post-surgery) was not statistically significant. Based on decision-making scales at each of the 4 time intervals, preparation for decision-making improved not only with time, but also after watching the surgical animations. Additionally, the decision-conflict was decreased at each time interval. Conclusions : T he SDSS improved patient's preparation for making a decision and reduced decisional conflict over the course of time and aided in their decision-making ability. These findings suggest that the SDSS is a useful tool to help LEP patients make a decision when given the options of a lumpectomy or a mastectomy. Our study also illustrates the effectiveness of a mixed-media SDSS for use as a tool to overcome the significant barriers of language and health literacy that exist for many ethnically diverse and LEP patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer cancer patient city decision support system hospital human interpersonal communication society surgeon EMTREE MEDICAL INDEX TERMS breast care computer consultation decision making Health Belief Model health literacy interview language mastectomy oncology partial mastectomy patient pilot study questionnaire satisfaction surgery surgical technique Theory of Planned Behavior LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71336410 DOI 10.1245/s10434-013-2964-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-2964-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 249 TITLE Accuracy of intraoperative assessment of sentinel node metastasis by measuring intranodal pressure AUTHOR NAMES Nathanson D. Shah R. Mahan M. AUTHOR ADDRESSES (Nathanson D.; Shah R.; Mahan M.) Henry Ford Health System, Detroit, United States. (Nathanson D.; Shah R.) Department of Surgery, Detroit, United States. (Mahan M.) Department of Public Health, Detroit, United States. CORRESPONDENCE ADDRESS D. Nathanson, Henry Ford Health System, Detroit, United States. SOURCE Annals of Surgical Oncology (2013) 20:2 SUPPL. 1 (88-89). Date of Publication: April 2013 CONFERENCE NAME 14th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2013-05-01 to 2013-05-05 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives : Many breast surgeons abide by the published ACOSOG Z0011 findings and don't advocate complete axillary lymph node dissection (CALND) following lumpectomy, sentinel lymph node (SLN) biopsy, irradiation, and systemic therapy for T1 and 2/ cN0/ pN1 invasive breast cancer. CALND is still usually recommended for patients undergoing mastectomy when the SLN is positive. CALND can be done during mastectomy or later when formal pathologic diagnosis is available. Frozen section confirmation of a positive SLN during mastectomy would be ideal but there is a high false-negative rate when the SLN is not obviously abnormal on palpation. Following our initial promising observations that intranodal pressure (INP) rises with increasing SLN metastasis size we set out to determine if intraoperative INP measurements and frozen section of the node to document pN1 SLN disease would aid the decision to do a CALND during mastectomy and avoid a second procedure. Method: INP was measured in 235 (SLN #1 N = 235; #2 N = 70) new breast cancer patients with T1/2, cN0 disease undergoing SLN biopsy. Level of suspicion (LOS) was assigned a score by clinical palpation of 0 = benign; 1 = slightly suspicious for metastasis; 2 = obvious metastasis in the SLN #1 (109) and SLN #2 (13) patients. The SLN pathology was assessed by intraoperative frozen-section only in patients undergoing mastectomy if the INP was higher than 18 mmHg, even when the LOS was zero or not recorded. CALND was done if the frozen section confirmed metastasis. Statistical analysis was performed to compare INP and SLN histology and: SLN metastasis (met) size (Spearman rank correlation coefficient); T grade, histology (Kruskal-Wallis); ER, PR, HER2-neu, LVI (Wilcoxen Mann-Whitney); frequency of SLN positivity among 6 groups combining LOS/INP (Fisher exact test); relationship of SLN positivity to LOS (GEE logistic regression). Results : SLN met size correlated with INP (r = 0.373; p < 0.001). INP in controls (prophylactic mastectomy, N = 9; mastectomy for DCIS, N = 17) was significantly different (p = 0.013) from invasive cancers (7.4 ± 5.2 vs 7.6 ± 4.7 vs 13.2 ± 10 mmHg, respectively). Lymphovascular invasion (LVI) with positive SLNs exhibited the highest INP (22.9 ± 14.2 mmHg; p < 0.009). Six groups created by combining LOS 0, 1, and 2 with INP >18 or <18 mmHg showed a significant (p < 0.001) correlation with SLN histology; LOS = 2/INP >18, N = 7, were all (100%) positive with no negative SLNs; LOS = 0/INP < 18, N = 78, had 4 (5%) SLNs positive all <4 mm in size. An important group is LOS = 0/IN > 18, 4 (44.4%) of 9 SLN positive. LOS alone was correct (p < 0.001) in negative and positive SLN prediction (90% and 100%, respectively, for LOS = 0 or 2). INP >24 mmHg correctly predicted SLN positive in 16/22 (73%) patients and INP < 10 correctly predicted negative SLNs in 108/110 (98%). Conclusions : INP and LOS were both good at predicting pN1 in cN0 patients. When used together they were good at predicting negative nodes. In a small number of cases, when LOS = 0, an elevated INP prompted intraoperative frozen section during mastectomy and proved metastasis. Pathologic documentation of SLN metastasis by immediate frozen section during mastectomy may justify a CALND where a second operation can be avoided. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast human metastasis society surgeon EMTREE MEDICAL INDEX TERMS axillary lymph node biopsy breast cancer cancer patient correlation coefficient diagnosis documentation Fisher exact test frozen section histology intraductal carcinoma irradiation logistic regression analysis lymph node dissection lymph vessel metastasis mastectomy palpation partial mastectomy pathology patient prediction procedures sentinel lymph node biopsy statistical analysis systemic therapy tumor invasion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71336478 DOI 10.1245/s10434-013-2964-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-2964-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 250 TITLE Factors associated with surgical decision making in women with early-stage breast cancer: A literature review AUTHOR NAMES Bride M.B.M. Neal L. Dilaveri C.A. Sandhu N.P. Hieken T.J. Ghosh K. Wahner-Roedler D.L. AUTHOR ADDRESSES (Bride M.B.M., macbride.maire@mayo.edu; Neal L.; Dilaveri C.A.; Sandhu N.P.; Ghosh K.; Wahner-Roedler D.L.) Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. (Hieken T.J.) Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, United States. CORRESPONDENCE ADDRESS M.B.M. Bride, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Email: macbride.maire@mayo.edu SOURCE Journal of Women's Health (2013) 22:3 (236-242). Date of Publication: 1 Mar 2013 ISSN 1540-9996 1931-843X (electronic) BOOK PUBLISHER Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States. ABSTRACT Background: Current recommendations for surgical management of early-stage breast cancer include breast-conserving surgery with postoperative irradiation. However, studies show that mastectomy is still being used by women with early-stage breast cancer. Methods: Review of the medical literature published between 2000 and 2010 to determine the factors associated with the decision of patients for surgical treatment in early-stage breast cancer. Results: The following patient characteristics affect the surgical decision-making process in early-stage breast cancer: age, socioeconomic factors, geographic area in which the patient lives, proximity to a radiation therapy center, testing for BRCA gene, breast imaging, and decision aids. Conclusions: Of increasing importance in the decision making about treatment of women with early-stage breast cancer are the woman's perception of having a surgical choice and the influence of that choice on postoperative quality of life. © Mary Ann Liebert, Inc. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy patient decision making EMTREE MEDICAL INDEX TERMS African American age distribution cancer radiotherapy cancer staging cancer surgery educational status ethnicity gene mutation genetic analysis geographic distribution health care access health care facility Hispanic human marriage nuclear magnetic resonance imaging perception priority journal quality of life review socioeconomics EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013174112 MEDLINE PMID 23428286 (http://www.ncbi.nlm.nih.gov/pubmed/23428286) PUI L368549438 DOI 10.1089/jwh.2012.3969 FULL TEXT LINK http://dx.doi.org/10.1089/jwh.2012.3969 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 251 TITLE Retrospective analysis of treatment decisions in patients with intermediate recurrence score results AUTHOR NAMES Fried G. Moskovitz M. AUTHOR ADDRESSES (Fried G.; Moskovitz M.) Oncology, Rambam Health Care Campus, Haifa, Israel. CORRESPONDENCE ADDRESS G. Fried, Oncology, Rambam Health Care Campus, Haifa, Israel. SOURCE Breast (2013) 22 SUPPL. 1 (S84-S85). Date of Publication: March 2013 CONFERENCE NAME 13th International Conference of the Primary Therapy of Early Breast Cancer CONFERENCE LOCATION St.Gallen, Switzerland CONFERENCE DATE 2013-03-13 to 2013-03-16 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Goals: The Oncotype DX® assay is validated as a prognosticator and a predictor of likelihood of chemotherapy benefit in ER positive early breast cancer (ERBC). Patients (pts) with high Recurrence Score results have significant benefit from chemotherapy and pts with low Recurrence Score results have minimal, if any benefit. Some pts with intermediate Recurrence Score results may have a moderate benefit from chemotherapy, increasing the importance of considering other clinical and pathological parameters associated with risk of recurrence in order to optimize treatment decisions. The aim of this study was to assess the impact of intermediate Recurrence Score results and other factors on treatment decisions. Methods: A retrospective study of ERBC with intermediate Recurrence Score results treated between 2005 and 2010 in a single institution was performed and identified 116 pts. The physician's recommendations prior to knowing the Recurrence Score results were consistently recorded and clinicopathological features and treatment decisions were obtained from pts' records. Five patients had missing data and were excluded. Results: Before receiving the Recurrence Score result, 33 pts (29.7%) were recommended chemo-hormonal therapy (CHT) and 78 pts (70.3%) were recommended hormonal therapy (HT) alone. After receiving the Recurrence Score result, 13/33 (39%) pts originally recommended CHT received HT and 11/78 (14%) of pts originally recommended HT received CHT. Overall, 24/111 (22%) pts received different treatment than that recommended prior to knowing the Recurrence Score result. Pts who received CHT (n = 30) had higher Recurrence Score results and younger mean age than those who received HT (n = 81). The change rate was similar in grade 2 (24.1%) and grade 3 (27.3%), but lower in grade 1 tumors (6.6%) (p = 0.27). There was a trend (p = 0.06) towards larger tumor size in CHT-recommended pts compared to HT-recommended pts. Conclusion: A clinically relevant proportion of pts with intermediate Recurrence Score results had a change in treatment decisions demonstrating that clinicians considered intermediate Recurrence Score results to be informative. Younger pts and pts with higher intermediate scores tended to be recommended CHT and pts with lower intermediate scores tended to be recommended HT alone. Changes occurred in all grades but were more likely in grade 2 and 3 tumors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer human patient therapy EMTREE MEDICAL INDEX TERMS assay chemotherapy hormonal therapy neoplasm parameters physician retrospective study risk tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71927376 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 252 TITLE Development and field test of a web-based patient decision aid about fertility preservation for breast cancer patients AUTHOR NAMES Ter Louwe L.A. Ter Kuile M.M. Fischer M.J. Garvelink M.M. Baas-Thijssen M.C.M. Hilders C.G.J.M. Stiggelbout A.M. AUTHOR ADDRESSES (Ter Louwe L.A.; Ter Kuile M.M.; Fischer M.J.; Garvelink M.M.; Baas-Thijssen M.C.M.; Hilders C.G.J.M.; Stiggelbout A.M.) Leiden University Medical Center, Netherlands. CORRESPONDENCE ADDRESS L.A. Ter Louwe, Leiden University Medical Center, Netherlands. SOURCE Journal of Sexual Medicine (2013) 10 SUPPL. 1 (151). Date of Publication: February 2013 CONFERENCE NAME Cancer Survivorship and Sexual Health Symposium 2011 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2011-06-17 to 2011-06-19 ISSN 1743-6095 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: According to the recommendations of the American Society of Clinical Oncology, options of fertility preservation should be considered early after the diagnosis of breast cancer. To inform patients about such options and the consequences of their choice, a Web-based patient decision aid (pDA) was developed by the authors. A values clarification exercise with online summary is part of the pDA. The pDA was next revised by medical oncologists, gynecologists, nurse practitioners, and a text writer. Before the start of an evaluation study, a field test was conducted to investigate acceptability and to get suggestions for improvement. Design and Methods: The field test of the pDA consisted of semistructured interviews with 12 patients, selected from the database of patients with breast cancer, who had been informed about fertility preservation options in the past. Every paragraph of the website was evaluated for understanding, length of information, relevance, and use of pictures, graphics and tables, using questions with open answers or answers on a five-point scale. Every comment was registered. The interviews were audio-recorded, transcribed, and coded by two independent researchers. Results: All patients were enthusiastic about this type of information. They found the Web site to be informative, useful, worth reading and easy to understand. They suggested to shorten some text parts. Patients stated that the Web site was a source of information that they had missed at the time of diagnosis, when they had to decide about options for fertility preservation. The Web site will be presented. Conclusion: The positive evaluation of this Web-based pDA has led to improvements. According to this small group of patients Web-based information can be of great help for newly diagnosed breast cancer patients in decision-making about fertility preservation options. Our research group is preparing a nationwide study to compare the Webbased pDA and usual care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human neoplasm patient reproductive procedure sexual health EMTREE MEDICAL INDEX TERMS data base decision making diagnosis evaluation study exercise gynecologist interview nurse practitioner oncology reading scientist semi structured interview society LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71024202 DOI 10.1111/jsm.12079_2 FULL TEXT LINK http://dx.doi.org/10.1111/jsm.12079_2 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 253 TITLE The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study. AUTHOR NAMES Shaffer V.A. Owens J. Zikmund-Fisher B.J. AUTHOR ADDRESSES (Shaffer V.A., shafferv@health.missouri.edu) University of Missouri, Department of Health Sciences, School of Health Professions, Department of Psychological Sciences, College of Arts & Science, Columbia, MO, United States. (Owens J.; Zikmund-Fisher B.J.) CORRESPONDENCE ADDRESS V.A. Shaffer, Email: shafferv@health.missouri.edu SOURCE Journal of medical Internet research (2013) 15:12 (e273). Date of Publication: 2013 ISSN 1438-8871 (electronic) ABSTRACT Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories. The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system Internet telemedicine EMTREE MEDICAL INDEX TERMS adult aged article breast cancer decision aids decision making eye movement eye tracking female human information seeking middle aged patient participation personal narratives psychological aspect videorecording LANGUAGE OF ARTICLE English MEDLINE PMID 24345424 (http://www.ncbi.nlm.nih.gov/pubmed/24345424) PUI L563081552 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 254 TITLE Patient decision aids for cancer treatment: Are there any alternatives? AUTHOR NAMES Spiegle G. Al-Sukhni E. Schmocker S. Gagliardi A.R. Victor J.C. Baxter N.N. Kennedy E.D. AUTHOR ADDRESSES (Spiegle G.; Al-Sukhni E.; Gagliardi A.R.; Victor J.C.; Baxter N.N.; Kennedy E.D., ekennedy@mtsinai.on.ca) University of Toronto, Toronto, ON, Canada. (Spiegle G.; Al-Sukhni E.; Schmocker S.; Kennedy E.D., ekennedy@mtsinai.on.ca) Division of General Surgery, Mount Sinai Hospital, Samuel Lunenfeld Research Institute, 600 University Avenue, Toronto, ON M5G 1X5, Canada. (Al-Sukhni E.; Schmocker S.; Kennedy E.D., ekennedy@mtsinai.on.ca) Zane Cohen Centre for Digestive Diseases, Toronto, ON, Canada. (Gagliardi A.R.) Toronto General Hospital, Toronto General Research Institute, Toronto, ON, Canada. (Victor J.C.; Baxter N.N.) Institute of Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. (Gagliardi A.R.; Victor J.C.; Baxter N.N.; Kennedy E.D., ekennedy@mtsinai.on.ca) Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. (Baxter N.N.) Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. (Kennedy E.D., ekennedy@mtsinai.on.ca) Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada. CORRESPONDENCE ADDRESS E.D. Kennedy, Division of General Surgery, Mount Sinai Hospital, Samuel Lunenfeld Research Institute, 600 University Avenue, Toronto, ON M5G 1X5, Canada. Email: ekennedy@mtsinai.on.ca SOURCE Cancer (2013) 119:1 (189-200). Date of Publication: 1 Jan 2013 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background: Although patient decision aids (pDAs) are effective, widespread use of pDAs for cancer treatment has not been achieved. The objectives of this study were to perform a systematic review to identify alternate types of decision support interventions (DSIs) for cancer treatment and a meta-analysis to compare the effectiveness of these DSIs to pDAs. Methods: The inclusion criteria for the study were: 1) all published studies using a randomized, controlled trial design, and 2) DSIs involving treatment decision-making for breast, prostate, colorectal, and/or lung cancer. For this analysis, DSIs were classified as pDAs if: 1) one reported outcome measure mapped onto the International Patient Decision Aids Standards Collaboration effectiveness criterion, and 2) the DSI was evaluated relative to standard consultation. Random effects models were used to compare the effectiveness of pDAs relative to other identified DSIs for reported outcomes. Results: A total of 71 studies were reviewed, and 24 met the inclusion criteria. Overall, there were no significant differences in knowledge, satisfaction, anxiety, or decisional conflict scores between pDAs and other DSIs. Conclusions: This study showed that the effectiveness of other DSIs, including question prompt lists and audiorecording of the consultation, is similar to pDAs. This is important because it may be that these less complex DSIs may be all that is necessary to achieve similar outcomes as pDAs for cancer treatment. © 2012 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer therapy patient decision aid patient decision making EMTREE MEDICAL INDEX TERMS advanced cancer anxiety article attitude to health audio recording breast cancer (diagnosis, radiotherapy, surgery) cancer adjuvant therapy cancer radiotherapy cancer staging clinical evaluation colorectal cancer comparative effectiveness conflict consultation decision support intervention depression (diagnosis) early cancer (diagnosis) human lung cancer medical decision making meta analysis metastasis potential mood change partial mastectomy patient care patient satisfaction preoperative treatment priority journal prostate cancer (diagnosis, radiotherapy) randomized controlled trial (topic) scoring system standard systematic review treatment outcome EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013059882 MEDLINE PMID 22811383 (http://www.ncbi.nlm.nih.gov/pubmed/22811383) PUI L52121912 DOI 10.1002/cncr.27641 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.27641 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 255 TITLE Cost-benefit analysis of decision support methods for patients with breast cancer in a rural community AUTHOR NAMES Wilson L. Loucks A. Stupar L. O'Donnell S. Moore D. Belkora J. AUTHOR ADDRESSES (Wilson L., wilsonL@pharmacy.ucsf.edu) Department of Medicine, University of California, Box 0613, San Francisco, CA 94143, United States. (Wilson L., wilsonL@pharmacy.ucsf.edu; Loucks A.) Department of Clinical Pharmacy, University of California, San Francisco, United States. (Stupar L.; Belkora J.) Department of Surgery, University of California, San Francisco, United States. (Stupar L.; Belkora J.) Department of Health Policy, University of California, San Francisco, United States. (O'Donnell S.) Cancer Resource Centers of Mendocino County, Mendocino, CA, United States. (Moore D.) Department of Statistics, California Pacific Medical Center, San Francisco, United States. CORRESPONDENCE ADDRESS L. Wilson, Department of Medicine, University of California, Box 0613, San Francisco, CA 94143, United States. Email: wilsonL@pharmacy.ucsf.edu SOURCE Community Oncology (2013) 10:2 (47-57). Date of Publication: February 2013 ISSN 1548-5315 BOOK PUBLISHER Elsevier Oncology ABSTRACT Background Decision support interventions help patients who are facing difficult treatment decisions and improve shared decision making. There is little evidence of the economic impact of these interventions. Objective To determine the costs of providing a decision support intervention in the form of consultation planning (CP) and consultation planning with recording and summary (CPRS) to women with breast cancer and to compare the cost benefit of CP and CPRS by telephone versus in person. Methods Sixty-eight women with breast cancer who were being treated at a rural cancer resource center were randomized to CP in person or by telephone. All participants were then provided with an audio-recording of the physician consultation along with a typed summary for the full intervention (CPRS). Surveys completed by the participants and center staff provided data for measuring costs and willingness-to-pay (WTP) benefits. Societal perspective costs and incremental net benefit (INB) across delivery methods was determined. Results Total CP costs were $208.72 for telephone and $264.00 for in-person delivery. Significantly lower telephone-group costs (P < .001) were a result of lower participant travel expenses. Participants were willing to pay $154.12 for telephone and $144.03 for in-person CP (P = .85). WTP did not exceed costs of either delivery method compared with no intervention. INB of providing CP for telephone versus in person was $65.37, favoring telephone delivery. Sensitivity analysis revealed that with more efficient CP training, WTP became greater than the costs of delivering CP by telephone versus no intervention. Limitations There may be some income distribution effects in the measurement of WTP. Conclusions Providing CP by telephone was significantly less costly with no significant difference in benefit. Participants' WTP only exceeded the full cost of CP with more efficient training or higher participant volume. A positive INB showed telephone delivery is efficient and may increase accessibility to decision support services, particularly in rural communities. © 2013 Frontline Medical Communications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management) cost benefit analysis decision support system rural population EMTREE MEDICAL INDEX TERMS adult article audio recording cancer center comparative study consultation controlled study female health care survey human major clinical study middle aged patient participation randomized controlled trial sensitivity analysis EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014325834 PUI L373059068 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 256 TITLE Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer AUTHOR NAMES Banegas M.P. McClure J.B. Barlow W.E. Ubel P.A. Smith D.M. Zikmund-Fisher B.J. Greene S.M. Fagerlin A. AUTHOR ADDRESSES (Banegas M.P., banegasmp@mail.nih.gov) University of Washington, Department of Health Services, Seattle, United States. (Banegas M.P., banegasmp@mail.nih.gov) Fred Hutchinson Cancer Research Center, Seattle, United States. (McClure J.B.; Greene S.M.) Group Health Research Institute, Seattle, United States. (Barlow W.E.) Cancer Research and Biostatistics, Seattle, United States. (Ubel P.A.) Fuqua School of Business, Duke University, Durham, United States. (Ubel P.A.) Sanford School of Public Policy, Duke University, Durham, United States. (Smith D.M.) Department of Preventive Medicine, Stony Brook University, Stony Brook, United States. (Zikmund-Fisher B.J.; Fagerlin A., fagerlin@umich.edu) Center for Bioethics and Social Sciences in Medicine, Ann Arbor, United States. (Zikmund-Fisher B.J.) Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, United States. (Zikmund-Fisher B.J.; Fagerlin A., fagerlin@umich.edu) Department of Internal Medicine, University of Michigan, Ann Arbor, United States. (Zikmund-Fisher B.J.) Risk Science Center, University of Michigan, Ann Arbor, United States. (Fagerlin A., fagerlin@umich.edu) VA Ann Arbor Center for Clinical Management Research, Ann Arbor, United States. (Fagerlin A., fagerlin@umich.edu) Department of Psychology, University of Michigan, Ann Arbor, United States. CORRESPONDENCE ADDRESS M.P. Banegas, National Cancer Institute, 6120 Executive Boulevard, MSC 7105, Bethesda, MD 20892, United States. Email: banegasmp@mail.nih.gov SOURCE Patient Education and Counseling (2013) 91:3 (364-371). Date of Publication: June 2013 ISSN 1873-5134 (electronic) 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objective: To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use. Methods: Postmenopausal women, age 46-74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (. n=. 690), Time 1 control (. n=. 160), or 3-month control (. n=. 162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively. Results: Intervention participants had significantly lower decisional conflict levels at post-test (. p<. 0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (. p<. 0.001) compared to control participants. Conclusion: GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk. Practice implications: Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values. © 2013 . EMTREE DRUG INDEX TERMS raloxifene (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, prevention) decision support system EMTREE MEDICAL INDEX TERMS adult aged article cancer risk conflict controlled study drug use female follow up high risk patient human individualization Internet major clinical study patient decision making priority journal prophylaxis randomized controlled trial CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013285495 MEDLINE PMID 23395006 (http://www.ncbi.nlm.nih.gov/pubmed/23395006) PUI L52426897 DOI 10.1016/j.pec.2012.12.014 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2012.12.014 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 257 TITLE Factors influencing the surgery intentions and choices of women with early breast cancer: The predictive utility of an extended Theory of Planned Behaviour AUTHOR NAMES Sivell S. Elwyn G. Edwards A. Manstead A. AUTHOR ADDRESSES (Sivell S.) Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom. (Elwyn G.; Edwards A.) Cochrane Institute of Primary Care and Public Health, Cardiff University, School of Medicine, Cardiff, United Kingdom. (Manstead A.) School of Medicine, Cardiff University, Cardiff, United Kingdom. CORRESPONDENCE ADDRESS S. Sivell, Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Cardiff, United Kingdom. SOURCE Psycho-Oncology (2013) 22 SUPPL. 1 (12). Date of Publication: January 2013 CONFERENCE NAME Abstracts of the British Psychosocial Oncology 2013 Conference, BPOS 2013 CONFERENCE LOCATION Southampton, United Kingdom CONFERENCE DATE 2013-01-17 to 2013-01-18 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women's choices. An extended Theory of Planned Behaviour (TPB) is likely to provide a basis to understand and predict women's surgery choices. AIMS: To understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, using an extended TPB. METHODS: Sixty-two women recruited from three UK breast clinics participated in the study; 48 women completed online questionnaires before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options, and surgery intentions. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. RESULTS: The extended TPB accounted for 69.9% of the variance in intentions (p < 0.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p < 0.01). CONCLUSIONS: These findings demonstrate the utility of an extended TPB in predicting and understanding women's surgery intentions and choices for early breast cancer. Understanding these factors may help identify key components of interventions to support women while considering their surgery options. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female human oncology surgery Theory of Planned Behavior EMTREE MEDICAL INDEX TERMS breast decision support system hospital logistic regression analysis mastectomy questionnaire radiotherapy survival rate United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71175879 DOI 10.10002/pon.3239 FULL TEXT LINK http://dx.doi.org/10.10002/pon.3239 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 258 TITLE Advances in breast surgery, 2002-2012 AUTHOR NAMES Edge S.B. AUTHOR ADDRESSES (Edge S.B., Stephen.edge@roswellpark.org) Roswell Park Cancer Institute, University at Buffalo, Buffalo, NY, United States. (Edge S.B., Stephen.edge@roswellpark.org) Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States. CORRESPONDENCE ADDRESS S.B. Edge, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States. Email: Stephen.edge@roswellpark.org SOURCE JNCCN Journal of the National Comprehensive Cancer Network (2013) 11:1 (53-59). Date of Publication: 1 Jan 2013 ISSN 1540-1405 1540-1413 (electronic) BOOK PUBLISHER Harborside Press, 37 main Street, Cold Spring Harbor, United States. ABSTRACT The past 40 years have brought dramatic changes in breast cancer treatments, resulting in a 30% reduction in breast cancer mortality. This is largely the result of new concepts tested in a steady stream of large, well-designed, coordinated clinical trials. Early trials showed that extended surgery ("local therapy") does not improve mortality over less aggressive surgery. Trials conducted in the 1970s and 1980s clearly showed that radical surgery involving removal of the breast provides no outcome advantage over breast-conserving therapy (BCT). One concern with BCT has been a higher rate of local recurrence compared with mastectomy, with initial studies before the routine use of systemic therapy reporting rates of 10% to 20% with BCT. Modern series define a risk of local recurrence after BCT of 2% to 5%, about the same as with mastectomy. The improvement is partly due to improved standards in surgery, radiation oncology, and pathology. However, it is primarily due to the use of systemic endocrine and chemotherapy. BCT is appropriate for most women with breast cancer. This article explores the advancements in breast surgery over the past 10 years. Copyright © 2013, JNCCN-Journal of the National Comprehensive Cancer Network. EMTREE DRUG INDEX TERMS trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery cancer surgery EMTREE MEDICAL INDEX TERMS breast cancer (drug therapy, radiotherapy, surgery) breast reconstruction cancer adjuvant therapy cancer chemotherapy cancer hormone therapy cancer survival clinical trial (topic) composite skin graft decision support system deep inferior epigastric perforator flap health care delivery health care quality human intraoperative radiotherapy mastectomy nuclear magnetic resonance imaging partial mastectomy plastic surgery preoperative care review sentinel lymph node biopsy surgical technology CAS REGISTRY NUMBERS trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013140498 MEDLINE PMID 23307981 (http://www.ncbi.nlm.nih.gov/pubmed/23307981) PUI L368454580 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 259 TITLE [Promoting citizen participation in healthcare through PyDEsalud.com]. ORIGINAL (NON-ENGLISH) TITLE Promoción de la participación ciudadana en cuidados de salud a través de PyDEsalud.com. AUTHOR NAMES Perestelo-Pérez L. Pérez-Ramos J. Abt-Sacks A. Rivero-Santana A. Serrano-Aguilar P. AUTHOR ADDRESSES (Perestelo-Pérez L., lilisbeth.peresteloperez@sescs.es) Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, España. (Pérez-Ramos J.; Abt-Sacks A.; Rivero-Santana A.; Serrano-Aguilar P.) CORRESPONDENCE ADDRESS L. Perestelo-Pérez, Email: lilisbeth.peresteloperez@sescs.es SOURCE Gaceta sanitaria / S.E.S.P.A.S (2013) 27:5 (466-467). Date of Publication: 2013 Sep-Oct ISSN 1578-1283 (electronic) ABSTRACT This project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients' experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consumer health care delivery Internet EMTREE MEDICAL INDEX TERMS article decision making decision support system doctor patient relation human Participación del paciente patient participation patient satisfaction Relaciones médico-paciente Satisfacción del paciente toma de decisiones Técnicas de apoyo para la decisión LANGUAGE OF ARTICLE Spanish MEDLINE PMID 23465730 (http://www.ncbi.nlm.nih.gov/pubmed/23465730) PUI L563072174 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 260 TITLE Using decision aids to improve treatment choices for women with breast cancer AUTHOR NAMES Peate M. Friedlander M.L. AUTHOR ADDRESSES (Peate M., michelle.peate@sydney.edu.au) Psycho-oncology Co-operative Research Group (PoCoG), Transient Building (F12), University of Sydney, Sydney, 2006, Australia. (Friedlander M.L.) Prince of Wales Clinical School, University of NSW, Randwick, NSW, Australia. (Friedlander M.L.) Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia. CORRESPONDENCE ADDRESS M. Peate, Psycho-oncology Co-operative Research Group (PoCoG), Transient Building (F12), University of Sydney, Sydney, 2006, Australia. Email: michelle.peate@sydney.edu.au SOURCE Breast Cancer Management (2013) 2:1 (23-31). Date of Publication: January 2013 ISSN 1758-1923 1758-1931 (electronic) BOOK PUBLISHER Future Medicine Ltd., 2nd Albert Place, Finchley Central, London, United Kingdom. ABSTRACT Breast cancer is the most frequently diagnosed cancer in women worldwide and decision-making regarding treatment options can be complex; however, patients often desire to be involved in health-related decisions. There has been a growing body of research into decision-support tools such as decision aids (DAs). Generally, DAs outperform standard care over a range of decision-making outcomes and there are some that have been developed for use with breast cancer patients across the treatment trajectory, which have been evaluated for use in practice. There is scope for developing additional DAs for cancer patients, however, there are some limitations and barriers that need to be overcome as part of the implementation process. Consideration for the mechanisms for maintaining relevancy of materials and ease of accessibility is also needed. © 2013 Future Medicine Ltd. EMTREE DRUG INDEX TERMS antineoplastic agent (adverse drug reaction, drug therapy) aromatase inhibitor (adverse drug reaction, drug therapy) tamoxifen (adverse drug reaction, drug therapy) trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant therapy amenorrhea (side effect) arthralgia (side effect) breast reconstruction cancer adjuvant therapy cancer hormone therapy cancer mortality cancer patient cancer radiotherapy cancer recurrence cardiotoxicity (side effect) decision making early menopause (side effect) hair loss (side effect) hot flush (side effect) human leukemia (side effect) leukocyte count mastectomy memory disorder (side effect) metastatic breast cancer nausea (side effect) neurotoxicity (side effect) osteolysis osteoporosis (side effect) overall survival partial mastectomy patient satisfaction priority journal recurrence free survival review sexual dysfunction (side effect) side effect (side effect) weight gain DRUG TRADE NAMES herceptin CAS REGISTRY NUMBERS tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012753068 PUI L366338638 DOI 10.2217/bmt.12.61 FULL TEXT LINK http://dx.doi.org/10.2217/bmt.12.61 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 261 TITLE 13th St. Gallen international breast cancer conference 2013: Primary therapy of early breast cancer evidence, controversies, consensus - Opinion of a German team of experts (Zurich 2013) AUTHOR NAMES Untch M. Gerber B. Harbeck N. Jackisch C. Marschner N. Möbus V. Von Minckwitz G. Loibl S. Beckmann M.W. Blohmer J.-U. Costa S.-D. Decker T. Diel I. Dimpfl T. Eiermann W. Fehm T. Friese K. Jänicke F. Janni W. Jonat W. Kiechle M. Köhler U. Lück H.-J. Maass N. Possinger K. Rody A. Scharl A. Schneeweiss A. Thomssen C. Wallwiener D. Welt A. AUTHOR ADDRESSES (Untch M., Michael.untch@helios-kliniken.de) Klinik Für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, Berlin, Germany. (Gerber B.) Universitätsfrauenklinik Rostock, Germany. (Harbeck N.) Brustzentrum, Frauenklinik der Universität München ( LMU), München, Germany. (Jackisch C.) Klinik Für Gynäkologie und Geburtshilfe, Klinikum Offenbach, Germany. (Marschner N.) Gemeinschaftspraxis Für Interdisziplinäre Onkologie und Hämatologie, Freiburg i.Br., Germany. (Möbus V.) Klinik Für Gynäkologie und Geburtshilfe, Klinikum Frankfurt-Höchst, Frankfurt/M., Germany. (Von Minckwitz G.) German Breast Group, Universitäts-Frauenklinik Frankfurt/M, Senologische Onkologie, Düsseldorf, Germany. (Loibl S.) German Breast Group, Neu-Isenburg, Germany. (Beckmann M.W.) Universitätsfrauenklinik Erlangen, Germany. (Blohmer J.-U.) St. Gertrauden Krankenhaus Berlin, Germany. (Costa S.-D.) Universitätsfrauenklinik Magdeburg, Germany. (Decker T.) Gemeinschaftspraxis Onkologie, Ravensburg, Germany. (Diel I.) Gemeinschaftspraxis Gynäkologie und Geburtshilfe, Mannheim, Germany. (Dimpfl T.) Klinik Für Frauenheilkunde und Geburtshilfe, Kassel, Germany. (Eiermann W.) Interdisziplinäres Onkologisches Zentrum, München, Germany. (Fehm T.) Universitätsfrauenklinik Düsseldorf, Germany. (Friese K.) Universitätsfrauenklinik München, Germany. (Jänicke F.) Klinik und Poliklinik Für Gynäkologie des Universitätsklinikums Hamburg-Eppendorf, Germany. (Janni W.) Universitätsfrauenklinik Ulm, Germany. (Jonat W.; Rody A.) Klinik Für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany. (Kiechle M.) Frauenklinik Rechts der Isar der Technischen Universität München, Germany. (Köhler U.) Klinik Für Gynäkologie und Geburtshilfe Am Klinikum St. Georg, Leipzig, Germany. (Lück H.-J.) Gynäkologisch-onkologische Praxis, Hannover, Germany. (Maass N.) Klinik Für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, Germany. (Possinger K.) Universitätsklinikum Charité Berlin, Germany. (Scharl A.) Frauenklinik, Klinikum St. Marien, Amberg, Germany. (Schneeweiss A.) Nationales Centrum Für Tumorerkrankungen, NCTund Universitätsfrauenklinik Heidelberg, Germany. (Thomssen C.) Universitätsklinik und Poliklinik Für Gynäkologie, Halle (Saale), Germany. (Wallwiener D.) Universitätsfrauenklinik Tübingen, Germany. (Welt A.) Westdeutsches Tumorzentrum des Universitätsklinikums Essen, Germany. CORRESPONDENCE ADDRESS M. Untch, Klinik Für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Schwanebecker Chaussee 50, Berlin, Germany. SOURCE Breast Care (2013) 8 (221-229). Date of Publication: 8 Oct 2013 ISSN 1661-3805 (electronic) 1661-3791 BOOK PUBLISHER S. Karger AG ABSTRACT The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radiotherapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed. EMTREE DRUG INDEX TERMS anthracycline bisphosphonic acid derivative cyclophosphamide epidermal growth factor receptor 2 (endogenous compound) tamoxifen trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) cancer therapy consensus development medical expert EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article axillary lymph node cancer adjuvant therapy cancer chemotherapy cancer radiotherapy estrogen receptor positive breast cancer follow up human lymph node dissection lymph node irradiation mastectomy molecular pathology partial mastectomy phase 3 clinical trial (topic) postmenopause stroma systemic therapy thorax wall treatment indication triple negative breast cancer CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) epidermal growth factor receptor 2 (137632-09-8) tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014892827 PUI L600410237 DOI 10.1159/000351692 FULL TEXT LINK http://dx.doi.org/10.1159/000351692 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 262 TITLE The St. Andrews recipient algorithm for breast reconstruction: a comparison analysis with other microsurgical units in the world. AUTHOR NAMES Liem A.A. Ramakrishnan V. AUTHOR ADDRESSES (Liem A.A.) St. Andrews Center for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK. (Ramakrishnan V.) CORRESPONDENCE ADDRESS A.A. Liem, St. Andrews Center for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK. SOURCE Plastic and reconstructive surgery (2013) 131:1 (127e-8e). Date of Publication: Jan 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) algorithm breast reconstruction decision support system free tissue graft microsurgery EMTREE MEDICAL INDEX TERMS anastomosis article comparative study epigastric artery (surgery) evaluation study female human mammary artery (surgery) methodology outcome assessment retrospective study transplantation United Kingdom vascularization LANGUAGE OF ARTICLE English MEDLINE PMID 23271543 (http://www.ncbi.nlm.nih.gov/pubmed/23271543) PUI L366386241 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 263 TITLE Breconda: Development and acceptability of an interactive decisional support tool for women considering breast reconstruction AUTHOR NAMES Sherman K.A. Harcourt D. Lam T. Boyages J. AUTHOR ADDRESSES (Sherman K.A.; Harcourt D.; Lam T.; Boyages J.) Macquarie University, Sydney, NSW, Australia; Westmead Hospital, University of Sydney, Westmead, NSW, Australia; University of the West of England, Bristol, United Kingdom CORRESPONDENCE ADDRESS K.A. Sherman, SOURCE Cancer Research (2012) 72:24 SUPPL. 3. Date of Publication: 15 Dec 2012 CONFERENCE NAME 35th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2012-12-04 to 2012-12-08 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Women needing a mastectomy for breast cancer, or cancer prophylaxis, are faced with the difficult decision regarding whether, and how, to restore breast shape after surgery. To a large extent this decision is based on personal preferences and values. In view of limited support resources available in this context, we have developed an online interactive decision aid, BRECONDA, to assist with decision-making. BRECONDA uses a multi-media platform to provide up-to-date information about surgical choices, interactive decision sheets encouraging women to weigh-up perceived benefits and risks and identify personal values and preferences, and video recorded patient stories. Since psychological stress can hamper decision-making, BRECONDA also demonstrates videoed stress management relaxation techniques. The aim of this study was to assess the user acceptability of this intervention. Methods: Following diagnosis, and prior to surgery, 54 women with breast cancer who were eligible for breast reconstruction following mastectomy were randomly assigned into one of two conditions: 1) Intervention group which received access to the BRECONDA program as well as a standard information booklet about breast surgery given to all such patients; and, 2) Control/Usual care group which received the standard information booklet alone. User ratings of satisfaction and reactions to BRECONDA were documented at 6-week follow-up for the Intervention group through quantitative measures and telephone interviews. Additionally, perceived decisional conflict, distress (intrusive and avoidant thoughts), knowledge and satisfaction with information at the 6-week assessment were documented for all participants. ANCOVAs were used to identify between group differences on these key variables at follow-up. Results: Intervention participants' ratings of BRECONDA demonstrated high user acceptability, with high scores on perceived usefulness, ease of use and provision of sufficient information. Interview data indicated that Intervention participants perceived BRECONDA to be well-balanced, informative, and beneficial to the decision making process and that it helped them feel more secure in their decision and to prepare questions for their surgeon. Interactive decision sheets, patient testimonials and photo galleries were highly valued by all interviewees. At follow-up, 40% of participants had undergone immediate reconstruction, with fewer Intervention participants electing this surgery. Furthermore, Intervention participants reported lower decisional conflict compared with Usual Care participants at follow-up (p <.05). Specifically, these participants reported feeling significantly clearer about personal values for benefits and risks of reconstruction compared with those receiving Usual Care. Conclusions: Users of the interactive online BRECONDA intervention reported high levels of user satisfaction with this innovative decisional support resource, as well as benefits in terms of experiencing less decisional conflict related to the ability to clarify the values that are personally important in the decision making context. This provides preliminary evidence for the acceptability and efficacy of this decision support intervention. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction female human EMTREE MEDICAL INDEX TERMS breast breast surgery cancer prevention decision making decision support system diagnosis follow up interview mastectomy mental stress patient personal value relaxation training risk satisfaction stress management surgeon surgery teleconsultation videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71097351 DOI 10.1158/0008-5472.SABCS12-P4-17-04 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS12-P4-17-04 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 264 TITLE Risk assessment and personalized decision support: the university of california athena breast health network AUTHOR NAMES Ozanne E.M. Crawford B. Petruse A. Madlensky L. Weiss L. Hogarth M. Wenger N. Goodman D. Park H. Anton-Culver H. Yasmeen S. Howell L. Ojeda H. Parker B.A. Kaplan C. Van't V.L. Esserman L. Naeim A. AUTHOR ADDRESSES (Ozanne E.M.; Crawford B.; Petruse A.; Madlensky L.; Weiss L.; Hogarth M.; Wenger N.; Goodman D.; Park H.; Anton-Culver H.; Yasmeen S.; Howell L.; Ojeda H.; Parker B.A.; Kaplan C.; Van't V.L.; Esserman L.; Naeim A.) University of California, San Francisco, CA; University of California, Los Angeles, CA; University of California, San Diego, CA; Athena Program Management Office, San Francisco, CA; University of California, Davis, CA; University of California, Irvine, CA CORRESPONDENCE ADDRESS E.M. Ozanne, SOURCE Cancer Research (2012) 72:24 SUPPL. 3. Date of Publication: 15 Dec 2012 CONFERENCE NAME 35th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2012-12-04 to 2012-12-08 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: The Athena Breast Health Network is a University of California (UC) initiative to drive rapid innovation in patient-centered prevention, screening, and treatment of breast cancer. Athena is a collaborative of the five UC medical centers and UC Berkeley that integrates clinical care and research, rapidly mobilizing data and research to enable continuous improvement in patient care and outcomes. The first initiative of Athena was to implement risk assessment for women being screened for breast cancer and to offer tailored referrals for women found to be at increased risk of developing breast cancer. Methods: Patients who enroll in Athena complete an electronic questionnaire to collect personal and family history data prior to their mammography screening visit. These data are used to generate multiple risk assessments using the NCCN and USPSTF guidelines, and BCRAT (Gail model). Data on established breast cancer risk factors such as chest wall radiation and history of hormone replacement therapy are also collected and used to identify women at potentially increased risk. Upon enrollment, women are given the opportunity to provide a blood or saliva sample for research purposes. Women who meet Athena-defined criteria that identify them to be at increased risk receive a referral to a Breast Health Specialist (BHS). The BHS identifies individual patient needs for prevention and screening services, including genetic counseling and testing, provides referrals to a High Risk Breast Clinic or nurse practitioner, and conducts lifestyle modification counseling. BHS have special training in breast cancer risk assessment, and some are licensed genetic counselors. Primary care and/or referring providers are directly informed of risk assessment results through mailings or the electronic medical record. Results: The recruitment goal enrollment for Athena is 150,000 and to date more than 17,000 women have been enrolled across the five centers. Of those enrolled, 32% indicated that they have a family history of cancer. 56% of the cohort consented to participate in research, and 40% provided a biospecimen for research purposes. Across the five centers, 32 educational outreach sessions about Athena were held, reaching approximately 375 providers. (Figure Presented) Conclusion: Successful implementation of the Athena risk assessment and decision support process will enable the identification of high risk women who are most likely to benefit from tailored screening or risk reducing interventions and who otherwise may not have been referred for risk reducing measures. By identifying women at the highest risk and connecting them to screening and prevention resources, the Athena Breast Health Network aims to ultimately reduce the incidence of breast cancer in its participant cohort. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer decision support system health risk assessment United States university EMTREE MEDICAL INDEX TERMS blood cancer risk counseling electronic medical record family history female genetic counseling hormone substitution hospital hospital patient human lifestyle modification mammography medical specialist model neoplasm nurse practitioner patient patient care prevention primary medical care questionnaire radiation risk risk factor saliva screening thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71097316 DOI 10.1158/0008-5472.SABCS12-P4-13-13 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS12-P4-13-13 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 265 TITLE Are web-based resources the breast?: An evaluation of the quality of online resources for breast cancer patients AUTHOR NAMES Nguyen S. Regehr G. Brar B. Lin J. Ingledew P. AUTHOR ADDRESSES (Nguyen S.; Regehr G.; Brar B.; Lin J.; Ingledew P.) British Columbia Cancer Centre, Fraser Valley Cancer Centre, Surrey, BC, Canada; Centre for Health Education Scholarship, Vancouver, BC, Canada; UBC, Vancouver, BC, Canada CORRESPONDENCE ADDRESS S. Nguyen, SOURCE Cancer Research (2012) 72:24 SUPPL. 3. Date of Publication: 15 Dec 2012 CONFERENCE NAME 35th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2012-12-04 to 2012-12-08 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Cancer patients are increasingly using the internet to seek disease specific information. Our prior studies indicate that a majority of breast cancer patients use the internet to aid decision making and to inform themselves about their disease. Although there is a substantial amount of information available on the internet regarding breast cancer, there are no comprehensive studies evaluating the quality of this information and whether it is adequate to support patients' decision making. The purpose of this study was to apply a validated evaluation tool to evaluate the quality of online breast cancer patient information. Methods: Using the principles of design-based research, an evaluation tool was developed and validated for the purposes of evaluation of web-based patient information. To review the quality of breast cancer information, a list of the top 100 breast cancer websites was systematically compiled using the meta-search engines Yippy and Dogpile, and the search engine Google. The websites were assessed for administration, accountability, authorship, organization, readability, and content. Inter-rater reliability was evaluated. Results were analyzed using descriptive statistics. Results: Over 2000 hits were initially obtained using the search term “breast cancer” (the most common search term according to our previous studies) in the three search engines. After applying the pre-specified inclusion and exclusion criteria the “top 100” breast cancer sites were evaluated. The majority of breast cancer websites were administered by commercial businesses (47%) and non-profit organizations (33%). 86% of the websites disclosed ownership, sponsorship, and/or advertising. Only 34% of websites identified the author and 39% cited sources. The average readability of websites was a grade 9 level. The majority of the information was out of date and only 27% of websites had updated their content within the last two years. While 88% of the websites sufficiently covered breast cancer, only 18% addressed prognosis. Conclusions: While a majority of breast cancer patients use the internet to obtain information on their diagnosis and treatment options, this study demonstrates that web-based information is variable and there are distressing gaps in the information available. Although the assessed websites were mostly accurate, there were significant deficits in authorship, attribution, and currency. Of concern, our research has previously demonstrated that patients use authorship and attribution to determine the reliability of web-based information. Additionally, very few websites provided information regarding prognosis, an area research has identified as an important topic sought by breast cancer patients. The results of this study can be used to counsel patients on the strengths and weaknesses of web-based breast cancer information and to empower patients to choose sites likely to enhance their personal knowledge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer cancer patient human EMTREE MEDICAL INDEX TERMS advertising cancer localization commercial phenomena decision making diagnosis Internet non profit organization organization and management patient patient information prognosis reading reliability search engine statistics weakness writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71097432 DOI 10.1158/0008-5472.SABCS12-P5-12-01 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS12-P5-12-01 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 266 TITLE Practice-centred work analysis: Towards ontology-based decision support in cross-boundary e-health AUTHOR NAMES Anya O. Tawfik H. Nagar A. AUTHOR ADDRESSES (Anya O., 08009472@hope.ac.uk; Tawfik H., tawfikh@hope.ac.uk; Nagar A., nagara@hope.ac.uk) Department of Computer Science, Liverpool Hope University, Liverpool L16 9JD, United Kingdom. CORRESPONDENCE ADDRESS O. Anya, Department of Computer Science, Liverpool Hope University, Liverpool L16 9JD, United Kingdom. Email: 08009472@hope.ac.uk SOURCE International Journal of Healthcare Technology and Management (2012) 13:5-6 (304-320). Date of Publication: 2012 Special Issue on User-Centred Health Informatics, Book Series Title: ISSN 1368-2156 1741-5144 (electronic) BOOK PUBLISHER Inderscience Enterprises Ltd., Editorial Office, P O Box 735, Olney, Bucks., MK46 5WB, United Kingdom. ABSTRACT Ontologies are increasingly used as artefacts for representing human knowledge for problem solving and decision making. Studies have shown that the actual knowledge used in problem solving and decision-making often occurs at the work practice level - the level that typically goes beyond functional notions of work processes to include a wide range of contextual, socio-cultural, situated and dynamically changing factors through which individuals, in getting work done, seek to construct meaning out of their experiences and engagement with the environment. However, it still remains an open question how much of the issues encompassed by a notion of work practice is accommodated in current ontology design approaches in system design. In this paper, the creation and use of ontologies is analysed from a practice-theoretic perspective in order to understand the processes of shared conceptualisation and role of ontologies in explicating knowledge about actual clinical work processes and problem situations. We illustrate this using a clinical work practice ontology, which we refer to as WOPRON, and show its capability for representing clinical work practice knowledge for cross-boundary decision support in e-health. © 2012 Inderscience Enterprises Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biomedicine clinical practice decision support system evidence based practice center information technology job analysis EMTREE MEDICAL INDEX TERMS article artifact breast cancer (surgery) cancer surgery cancer therapy clinical decision making computer conceptual framework cultural factor historical research hospital service human knowledge base mastectomy practice guideline problem solving social work practice stereotypy taxonomy theoretical study therapy work environment workplace EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013205548 PUI L368620546 DOI 10.1504/IJHTM.2012.052562 FULL TEXT LINK http://dx.doi.org/10.1504/IJHTM.2012.052562 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 267 TITLE Patient clinical profiles associated with physician non-compliance despite the use of a guideline-based decision support system: a case study with OncoDoc2 using data mining techniques. AUTHOR NAMES Séroussi B. Soulet A. Messai N. Laouénan C. Mentré F. Bouaud J. AUTHOR ADDRESSES (Séroussi B.) UPMC, UFR de Médecine, Paris, France. (Soulet A.; Messai N.; Laouénan C.; Mentré F.; Bouaud J.) CORRESPONDENCE ADDRESS B. Séroussi, UPMC, UFR de Médecine, Paris, France. SOURCE AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium (2012) 2012 (828-837). Date of Publication: 2012 ISSN 1942-597X (electronic) ABSTRACT OncoDoc2 is a guideline-based clinical decision support system (CDSS) applied to the management of breast cancer patients. OncoDoc2 has been routinely used during multidisciplinary staff meetings at the Tenon Hospital (Paris, France) for nearly 3 years. Despite the use of the CDSS that reminds physicians of the recommended treatments, the compliance rate of decisions is not 100%. We have used pattern mining techniques in order to elicit patient clinical profiles associated with non-compliance. We quantified each extracted pattern by three measures (support, growth rate, and unexpected rate) and we introduced a score to prune relevant emerging patterns. Non-compliance has concerned elderly patients in pre-surgery decisions, patients with micro invasive tumor in re-excision decisions, and patients HR+ and Her2+ in adjuvant decisions. In all cases, physician non-compliance with guidelines occurs when scientific evidence is lacking. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery, therapy) data mining decision support system practice guideline EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adjuvant therapy algorithm article expert system human mathematical phenomena physician preoperative care LANGUAGE OF ARTICLE English MEDLINE PMID 23304357 (http://www.ncbi.nlm.nih.gov/pubmed/23304357) PUI L369427551 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 268 TITLE Elicitating patient patterns of physician non-compliance with breast cancer guidelines using formal concept analysis. AUTHOR NAMES Bouaud J. Messai N. Laouénan C. Mentré F. Séroussi B. AUTHOR ADDRESSES (Bouaud J.) AP-HP, STIM, Paris, France. (Messai N.; Laouénan C.; Mentré F.; Séroussi B.) CORRESPONDENCE ADDRESS J. Bouaud, AP-HP, STIM, Paris, France. Email: jacques.bouaud@sap.aphp.fr SOURCE Studies in health technology and informatics (2012) 180 (477-481). Date of Publication: 2012 ISSN 0926-9630 ABSTRACT Because they provide patient-specific guideline-based recommendations, clinical decision support systems (CDSSs) are expected to promote the implementation of clinical practice guidelines (CPGs). OncoDoc2 is a CDSS applied to the management of breast cancer. However, despite it was routinely used during weekly multidisciplinary staff meetings (MSMs) at the Tenon Hospital (Paris, France), the compliance rate of MSMs' decisions with CPGs did not reach 100%. Formal Concept Analysis (FCA) has been applied to elicit formal concepts related to non-compliance. A statistical pre-treatment of attributes has been proposed to leverage FCA and discriminate between compliant and non-compliant decisions. Among the 1,889 decisions made over a 3 year-period, 199 decisions of recommended re-excisions have been considered for analysis. In this sample, non-compliance was explained by uncommon clinical profiles and specific patient-centred clinical criteria. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice decision support system neoplasm (epidemiology, therapy) oncology patient compliance practice guideline EMTREE MEDICAL INDEX TERMS article female France (epidemiology) human standard statistics LANGUAGE OF ARTICLE English MEDLINE PMID 22874236 (http://www.ncbi.nlm.nih.gov/pubmed/22874236) PUI L366370610 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 269 TITLE Clinical impact of an internet-based tool to help guide therapeutic changes while monitoring patients with chronic myeloid leukemia receiving first-line tyrosine kinase inhibitor therapy AUTHOR NAMES Obholz K.L. DeAngelo D.J. Mauro M.J. Shah N. Smith B.D. Bowser A. Peterson E.D. Radich J.P. AUTHOR ADDRESSES (Obholz K.L.; Bowser A.) Clinical Care Options, LLC, Reston, United States. (DeAngelo D.J.) Dana-Farber Cancer Institute, Boston, United States. (Mauro M.J.) Knight Cancer Institute, Oregon Health and Science University, Portland, United States. (Shah N.) University of California, San Francisco School of Medicine, San Francisco, United States. (Smith B.D.) Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Baltimore, United States. (Peterson E.D.) Annenberg Center for Health Sciences at Eisenhower, Rancho Mirage, United States. (Radich J.P.) Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, United States. CORRESPONDENCE ADDRESS K.L. Obholz, Clinical Care Options, LLC, Reston, United States. SOURCE Blood (2012) 120:21. Date of Publication: 16 Nov 2012 CONFERENCE NAME 54th Annual Meeting of the American Society of Hematology, ASH 2012 CONFERENCE LOCATION Atlanta, GA, United States CONFERENCE DATE 2012-12-08 to 2012-12-11 ISSN 0006-4971 BOOK PUBLISHER American Society of Hematology ABSTRACT Background: European LeukemiaNet (ELN) and National Comprehensive Cancer Network (NCCN) recommendations are important resources to help guide the management of patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitor (TKI) therapy. However, current guidelines are sometimes difficult to apply to all patient scenarios, particularly as they do not provide definite management recommendations for patients who have suboptimal responses to first-line TKI therapy. Furthermore, in a recent survey only 58% (N=132) of community oncologists made treatment decisions in line with expert recommendations for clinical scenarios in which patients had a suboptimal response to first-line therapy with imatinib. Online tools that provide expert clinical guidance have been proposed as one adjunctive approach to help clinicians make more informed treatment decisions. We previously reported that an online tool designed to provide expert guidance on adjuvant treatment of breast cancer may positively impact treatment decisions and thus potentially improve patient care (J Clin Oncol 29: 2011 [suppl; abstr 6063]). Aims/Objectives: The goal was to determine whether an interactive online decision support tool providing expert guidance would help community practitioners make more informed therapeutic decisions for patients with CML who were receiving first-line TKI therapy. We sought to evaluate to what extent the expert recommendations changed the community practitioners' clinical approach. Methods: An interactive decision support tool, developed with input from 5 CML experts who made treatment recommendations for 42 different patient scenarios, has been posted online at http://www.clinicaloptions.com/TreatingCML. Users of the tool enter specific factors such as patient age and duration of first-line TKI therapy, along with information on hematologic, cytogenetic, and/or molecular responses to first-line TKI therapy at 3, 6, 12 and 18 months. Before expert recommendations for that specific patient scenario are revealed, users are asked to enter their intended management approach. Once that is entered, the tool outputs a table showing the recommendations of the 5 CML experts based on the specific factors entered. Finally, the user is prompted to indicate whether the experts' recommendation confirmed or changed their intended management approach. User response data and intended treatment approaches will be tabulated and compared with the experts' recommendations. Results: This resource was posted online July 2012 and had 161 unique users with 219 uses of the tool in the first 40 days. Among the users to date, 15% indicated that the experts' recommendations changed their intended management approach. A separate analysis of the in-tool recommendations showed that the experts considered not only guidelines, but also emerging data and their own clinical experience in making recommendations for specific patient scenarios. For example, ahead of similar recommendations included in the most recent update to the NCCN treatment guidelines for CML, the experts added a consideration in the tool suggesting a BCR-ABL/ABL ratio of 10% by QPCR as the threshold for guiding a therapeutic change at 3 months. Moreover, most of the experts (4 of 5) recommended a therapeutic change for patients in CCyR without MMR at 12 months if there was a concomitant increase in BCR-ABL ratio of 1 log or more and (3 of 5) also recommended a therapeutic change for patients without a MMR at 18 months regardless of whether their BCR-ABL/ABL ratio was increasing. Detailed comparisons of expert and user responses will be presented. Conclusions: Preliminary data suggest that an online tool designed to provide customized, patient-specific expert advice may increase the number of clinicians who make optimal treatment decisions for patients with CML based on their response to first-line TKI therapy, and therefore, may be an important adjunct to the ELN and NCCN guidelines. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) protein tyrosine kinase inhibitor EMTREE DRUG INDEX TERMS imatinib salicylate sodium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chronic myeloid leukemia hematology human Internet monitoring patient society therapy EMTREE MEDICAL INDEX TERMS adjuvant therapy breast cancer community decision support system medical decision making neoplasm patient care physician LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70961935 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 270 TITLE Development of a patient decision aid for older women with stage I breast cancer considering adjuvant treatment postlumpectomy AUTHOR NAMES Szumacher E. Wong J. D'Alimonte L. Angus J. Paszat L. Metcalfe K. Whelan T. Llewellyn-Thomas H. Warner E. AUTHOR ADDRESSES (Szumacher E.; Wong J.; D'Alimonte L.; Paszat L.; Llewellyn-Thomas H.) Sunnybrook Health Sciences Centre, Toronto, Canada. (Angus J.; Metcalfe K.; Warner E.) University of Toronto, Toronto, Canada. (Whelan T.) Juravinski Cancer Centre, Hamilton, Canada. CORRESPONDENCE ADDRESS E. Szumacher, Sunnybrook Health Sciences Centre, Toronto, Canada. SOURCE International Journal of Radiation Oncology Biology Physics (2012) 84:3 SUPPL. 1 (S221). Date of Publication: 1 Nov 2012 CONFERENCE NAME 54th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2012 CONFERENCE LOCATION Boston, MA, United States CONFERENCE DATE 2012-10-28 to 2012-10-31 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): To develop a patient decision aid (DA) for older women with stage I, ER/PR positive breast cancer considering adjuvant treatment post-lumpectomy and to examine its impact on patients' treatment decision-making process. Materials/Methods: A DA was developed and evaluated in three steps following the Ottawa Decision Aid Framework: 1) Needs assessment (N= 16); 2) Pilot I, to examine the DA's acceptability (N = 12); and 3) Pilot II, a pre-test post-test (N = 38) with older women with ER/PR responsive breast cancer post-lumpectomy who were receiving adjuvant RT. Measures included questionnaires to assess patient's satisfaction with the DA, patients' self-reported decisional conflict (DC), level of distress, treatmentrelated knowledge, and choice predisposition. Results: The DA is a booklet that details each adjuvant treatment option's benefits, risks, and side-effects tailored to their clinical profile; includes a value clarification exercise; and steps to guide them towards their own treatment decision. Based on qualitative comments and satisfaction ratings, all women felt the DA was helpful and informative. Compared with baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the treatment benefits and risks (AMD, -10.86, CI, -20.33 to 21.49; and improved general treatment knowledge (AMD, 8.99, CI, 2.88 to 10.28) after using the DA. General trends were also reported in patient's choice predisposition scores suggesting potential differences in treatment decision after DA use. Conclusions: This study provides evidence that this DA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by using a tailored DA to help the patient be informed of their treatment options and to prepare for decisionmaking. EMTREE DRUG INDEX TERMS adjuvant methyldopa EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast cancer female human oncology patient society EMTREE MEDICAL INDEX TERMS cancer patient confidence interval decision making disease predisposition exercise hospital patient needs assessment partial mastectomy patient satisfaction potential difference questionnaire risk satisfaction side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70912988 DOI 10.1016/j.ijrobp.2012.07.573 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2012.07.573 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 271 TITLE The value of personalizing medicine: Medical oncologists' and patients' perspectives on genomic testing of breast tumours in chemotherapy treatment decisions AUTHOR NAMES Marshall D.A. Bombard Y. Rozmovits L. Trudeau M. Leighl N. Deal K. AUTHOR ADDRESSES (Marshall D.A.; Deal K.) McMaster University, Hamilton, Canada. (Bombard Y.) Memorial Sloan-Kettering Cancer Center, New York, United States. (Rozmovits L.) Independent Qualitative Researcher, Toronto, Canada. (Trudeau M.) Sunnybrook Health Science Centre, Toronto, Canada. (Leighl N.) Princess Margaret Hospital, Toronto, Canada. CORRESPONDENCE ADDRESS D.A. Marshall, McMaster University, Hamilton, Canada. SOURCE Value in Health (2012) 15:7 (A429). Date of Publication: November 2012 CONFERENCE NAME ISPOR 15th Annual European Congress CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2012-11-03 to 2012-11-07 ISSN 1098-3015 BOOK PUBLISHER Elsevier Ltd ABSTRACT OBJECTIVES: The benefit of adjuvant chemotherapy for early-stage breast cancer (BrCa) patients depends on baseline recurrence risk. Gene expression profiling (GEP) of tumours informs baseline risk prediction, potentially reducing unnecessary treatment and health care costs. Limited evidence exists on its clinical utility; we explored patients' and oncologists' perspectives on GEP in chemotherapy decisions. METHODS: We conducted individual interviews with medical oncologists (n=10), plus focus groups and individual interviews with BrCa patients (n=20) from Ontario, Canada. BrCa patients who underwent genomic testing ('OncotypeDx'), were recruited through oncology clinics from two academic hospitals in the Greater Toronto Area. Medical oncologists were recruited through participating oncology clinics, professional advertisements and referrals from the research team. Data were analyzed using interpretative qualitative methods, including content analysis, qualitative description and constant comparison techniques. RESULTS: Patients and oncologists valued GEP as an additional decision-support tool, complementing existing clinical indicators, though perceived utility varied between patients and oncologists. Patients valued the test highly, suggesting it was one of the primary determinants of their treatment decision. All patients followed the course of action their results suggested. Patients with intermediate scores often used the results to reinforce their pre-existing treatment preferences. Oncologists were mixed about the test's utility. Some considered it another tool supporting their approach to risk assessments; others used it more definitively to resolve their uncertainty. Oncologists explained the test's contribution to decision-making but remained uncertain about patients' understanding and expectations of the test. Some raised concerns about the variability of its use and interpretation within their medical community. CONCLUSIONS: Patients and oncologists valued the test, often using it as a primary determinant in their treatment decision, despite oncologists' concerns about its technical limitations and patients' limited understanding. Results identify need for informational decision aids and practice guidelines to support patient understanding and standardized application of the test. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast chemotherapy human patient EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy advertising breast cancer Canada cancer patient clinical indicator community content analysis decision making decision support system gene expression profiling health care cost hospital information processing interview oncology practice guideline prediction qualitative analysis recurrence risk risk risk assessment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70916790 DOI 10.1016/j.jval.2012.08.2151 FULL TEXT LINK http://dx.doi.org/10.1016/j.jval.2012.08.2151 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 272 TITLE Cost-effectiveness analysis of four validated techniques of accelerated partial breast irradiation for the treatment of early-stage breast cancer: Spanish public health system standard estimations AUTHOR NAMES Santos M. Guerra J.L.L. Gordillo M.J.O. Fondevilla A. Calvo F. Samblás J. Marsiglia H. AUTHOR ADDRESSES (Santos M.) Institut Gustave Roussy, Paris, France. (Guerra J.L.L.; Fondevilla A.; Calvo F.; Samblás J.; Marsiglia H.) Instituto Madrileño de Oncologia, Madrid, Spain. (Gordillo M.J.O.) Hospital Universitario Virgem del Rocio, Seville, Andaluzia, Spain. CORRESPONDENCE ADDRESS M. Santos, Institut Gustave Roussy, Paris, France. SOURCE Value in Health (2012) 15:7 (A354). Date of Publication: November 2012 CONFERENCE NAME ISPOR 15th Annual European Congress CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2012-11-03 to 2012-11-07 ISSN 1098-3015 BOOK PUBLISHER Elsevier Ltd ABSTRACT OBJECTIVES: Partial breast irradiation (PBI) can be considered a safe alternative to standard whole breast irradiation (WBI) in favourable early breast cancer and, profitably, is delivered in a shorter time. Four different techniques have been described in randomized trials (follow-up > 4 years): intraoperative-radiotherapy (IORT), delivered at the time of tumorectomy; low-dose-rate brachytherapy (LDR), delivered in 3 days; external-beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR), both delivered in 5 days. For comparison, WBI is delivered in seven weeks. The objective of this study was to compare the cost-effectiveness of the 4 different technical approaches to PBI, for the treatment of selected favourable early stage breast cancer patients, using current cost estimations within the Spanish Public Health System. METHODS: A decision-analysis model was performed using efficacy data from previous prospective trials, calculated in years without mastectomy (YWM). Direct costs were estimated based on charges applied by Madrid,s Autonomous Community, and were expressed in Euros (€). For each modality of PBI, local recurrence rates where individualized, and charges weighted for the frequency of its occurrence. A probabilistic sensitivity analysis was conducted to evaluate the robustness of the results. RESULTS: A total cost of 5488.25 € was estimated for EBRT, 6595.87 € for LDR, 7454.10 € for HDR, and 8895,71 € for IORT. The incremental cost-effectiveness ratio (ICER) comparing IORT to EBRT was 17209.41 €/YWM. All brachytherapy techniques (LDR and HDR) were dominated. Sensitivity analysis showed that ICER depends mainly on recurrence level after EBRT, but also on IORT costs. CONCLUSIONS: In a Spanish Public Health Care scenario, IORT shows a reasonable a cost-effectiveness ratio for patients with early stage breast cancer and, due to its intrasurgical administration (same hospital admission required for surgery), should be considered a compelling alternative, in particular for patients with complex transportation demands to access radiotherapy facilities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer cost effectiveness analysis health care irradiation public health EMTREE MEDICAL INDEX TERMS brachytherapy cancer patient cancer surgery community drug megadose external beam radiotherapy follow up hospital admission human intraoperative radiotherapy low drug dose mastectomy model patient public health service radiotherapy recurrence risk sensitivity analysis surgery traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70916393 DOI 10.1016/j.jval.2012.08.899 FULL TEXT LINK http://dx.doi.org/10.1016/j.jval.2012.08.899 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 273 TITLE A comprehensive evaluation of the quality of online resources for breast cancer patients AUTHOR NAMES Ingledew P. Brar B. Lin J. Nguyen S. Regehr G. AUTHOR ADDRESSES (Ingledew P.; Nguyen S.) B.C. Cancer Agency-FVCC, Surrey, Canada. (Brar B.; Lin J.; Regehr G.) UBC, Vancouver, Canada. CORRESPONDENCE ADDRESS P. Ingledew, B.C. Cancer Agency-FVCC, Surrey, Canada. SOURCE International Journal of Radiation Oncology Biology Physics (2012) 84:3 SUPPL. 1 (S251-S252). Date of Publication: 1 Nov 2012 CONFERENCE NAME 54th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2012 CONFERENCE LOCATION Boston, MA, United States CONFERENCE DATE 2012-10-28 to 2012-10-31 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Cancer patients are increasingly using the internet to seek disease specific information. Our prior studies indicate that a majority of breast cancer patients use the internet to aid decision making. There are no comprehensive studies evaluating the quality of breast cancer information on the internet and whether it is adequate to support patients' decision-making. The purpose of this study was to apply a validated evaluation tool to evaluate the quality of online breast cancer patient information. Materials/Methods: Using the principles of design-based research, an evaluation tool was developed and validated for the purposes of evaluation of web-based patient information. To review the quality of breast cancer web sites, a list of the top 100 sites was systematically compiled using the meta-search engines Yippy and Dogpile, and the search engine Google. The websites were assessed for administration, accountability, authorship, organization, readability, and content. Inter-rater reliability was evaluated. Results were analyzed using descriptive statistics. Results: Over 2,000 hits were initially obtained using the search term “breast cancer” in the three search engines. After applying the pre-specified inclusion and exclusion criteria the “top 100” breast cancer sites were evaluated. The majority of breast cancer websites were administered by commercial businesses (47%) and non-profit organizations (33%). Eightysix percent of the websites disclosed ownership, sponsorship, and/or advertising. Only 34% of websites identified the author and 39% cited sources. The average readability of websites was a grade 9 level. The majority of the information was out of date and only 27% of websites had updated their content within the last two years. While 88% of the websites sufficiently covered breast cancer, only 18% addressed prognosis. Conclusions: While a majority of breast cancer patients use the internet to obtain information on their diagnosis and treatment options, this study demonstrates that web-based information is variable and there are distressing gaps in the information available. Although the assessed websites were mostly accurate, there were significant deficits in authorship, attribution, and currency. Of concern, our research has previously demonstrated that patients use authorship and attribution to determine the reliability of web-based information. Additionally, very few websites provided information regarding prognosis, an area research has identified as an important topic sought by breast cancer patients. The results of this study can be used to counsel patients on the strengths and weaknesses of web-based breast cancer information and to empower patients to choose sites likely to enhance their personal knowledge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human oncology society EMTREE MEDICAL INDEX TERMS advertising cancer localization commercial phenomena decision making diagnosis Internet non profit organization organization and management patient patient information prognosis reading reliability search engine statistics weakness writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70913066 DOI 10.1016/j.ijrobp.2012.07.653 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2012.07.653 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 274 TITLE Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids AUTHOR NAMES Allen S.V. Solberg Nes L. Marnach M.L. Polga K. Jenkins S.M. Files J.A. Croghan I.T. Ghosh K. Pruthi S. AUTHOR ADDRESSES (Allen S.V., allen.summer@mayo.edu) Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. (Solberg Nes L., lsolbnes@umn.edu) Department of Medicine, University of Minnesota, D612 MMC 741, 420 Delaware Street SE, Minneapolis, MN 55455, United States. (Marnach M.L., marnach.mary@mayo.edu) Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. (Polga K., polga.kristen@marshfieldclinic.org) Division of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, United States. (Jenkins S.M., jenkins.sarah@mayo.edu) Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. (Files J.A., files.julia@mayo.edu) Division of Women's Health Internal Medicine, Mayo Clinic, 13737 North 92nd Street, Scottsdale, AZ 85260, United States. (Croghan I.T., croghan.ivana@mayo.edu) Primary Care Internal Medicine, Nicotine Research Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. (Ghosh K., ghosh.karthik@mayo.edu; Pruthi S., pruthi.sandhya@mayo.edu) Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. CORRESPONDENCE ADDRESS S. Pruthi, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Email: pruthi.sandhya@mayo.edu SOURCE BMC Women's Health (2012) 12 Article Number: 36. Date of Publication: 10 Oct 2012 ISSN 1472-6874 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: The purpose of the study was to examine patients' understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF) in 2009 addressing age at initiation and frequency of screening mammography.Methods: Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150) at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010).Results: Of the patients surveyed, 97/147 (67%) indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41%) reported increased anxiety about mammograms, and 58/146 (40%) reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%), did not expect to change their timing or frequency of screening mammograms in the future.Conclusion: Results from this survey suggested increased confusion and possibly an increase in patients' anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge. © 2012 Allen et al.; licensee BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening comprehension mammography practice guideline EMTREE MEDICAL INDEX TERMS adult aged anxiety article breast cancer female health status human patient attitude patient decision making EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012720787 MEDLINE PMID 23051022 (http://www.ncbi.nlm.nih.gov/pubmed/23051022) PUI L52253848 DOI 10.1186/1472-6874-12-36 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6874-12-36 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 275 TITLE Preoperative breast MRI in early-stage breast cancer AUTHOR NAMES Young P. Kim B. Malin J.L. AUTHOR ADDRESSES (Young P., pyoung@mednet.ucla.edu) Cedars Sinai Medical Center, 8700 Beverly Blvd Suite 5512, Los Angeles, CA 90048, United States. (Young P., pyoung@mednet.ucla.edu; Malin J.L.) VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. (Kim B.) Division of Hematology/Oncology, Department of Medicine, UCSF School of Medicine, San Francisco, CA, United States. (Kim B.; Malin J.L.) RAND Corporation, Santa Monica, CA, United States. (Malin J.L.) Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS P. Young, Cedars Sinai Medical Center, 8700 Beverly Blvd Suite 5512, Los Angeles, CA 90048, United States. Email: pyoung@mednet.ucla.edu SOURCE Breast Cancer Research and Treatment (2012) 135:3 (907-912). Date of Publication: October 2012 ISSN 0167-6806 1573-7217 (electronic) BOOK PUBLISHER Springer New York, 233 Spring Street, New York, United States. ABSTRACT Rapid uptake of new imaging technology is a major contributor to rising healthcare costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without the evidence of improved outcomes compared to standard assessment and is associated with higher rates of mastectomy. A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy on patient outcomes measured in quality-adjusted life years (QALYs). Model inputs, including survival, recurrence rates, and health utilities, were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard assessment. Preoperative MRI resulted in 17.77 QALYs compared to 17.86 QALYs with standard assessment, a decrease of 0.09 QALYs or 34 days. In sensitivity analyses, standard assessment was associated with better patient outcomes than preoperative breast MRI across all plausible probabilities for mastectomy, local recurrence, and health utilities. For routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1 % (versus the range of 3.6-33 % reported in the literature). Routine preoperative breast MRI appears to confer no advantage over the standard diagnostic evaluations for early-stage breast cancer and may lead to worse patient outcomes. © Springer Science+Business Media, LLC. 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) nuclear magnetic resonance imaging EMTREE MEDICAL INDEX TERMS cancer staging cancer survival decision support system health care utilization human mastectomy outcome assessment preoperative evaluation priority journal quality adjusted life year recurrence risk review sensitivity analysis EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012561257 MEDLINE PMID 22923237 (http://www.ncbi.nlm.nih.gov/pubmed/22923237) PUI L52178569 DOI 10.1007/s10549-012-2207-1 FULL TEXT LINK http://dx.doi.org/10.1007/s10549-012-2207-1 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 276 TITLE Prophylactic surgery in common hereditary cancer syndromes ORIGINAL (NON-ENGLISH) TITLE Indications et efficacité de la chirurgie prophylactique des cancers gynécologiques et digestifs avec prédisposition génétique AUTHOR NAMES Noguès C. Mouret-Fourme E. AUTHOR ADDRESSES (Noguès C., catherine.nogues@curie.net; Mouret-Fourme E., emmanuelle.fourme@curie.net) Institut Curie, Département de Santé Publique, Oncogénétique, 35 rue Dailly, 92210 St-Cloud, France. CORRESPONDENCE ADDRESS E. Mouret-Fourme, Institut Curie, Département de Santé Publique, Oncogénétique, 35 rue Dailly, 92210 St-Cloud, France. Email: emmanuelle.fourme@curie.net SOURCE Bulletin de l'Academie Nationale de Medecine (2012) 196:7 (1237-1245). Date of Publication: October 2012 ISSN 0001-4079 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT Preventive surgery is a mainstay of treatment for persons with genetic risk factors for cancer. The indications of preventive surgery are based on a thorough risk assessment, clinical characteristics of the different hereditary cancer susceptibility syndromes, the types of mutation, and the possibility of watchful waiting for early cancer detection. Preventive surgery may either be recommended or represent one possible option. Bilateral prophylactic mastectomy can reduce the risk of breast cancer by up to 95 % in BRCA1IBRCA2 mutation carriers. Bilateral prophylactic salpingo-oophorectomy is recommended for BRCA1I BRCA2 carriers: women who undergo this preventive surgery have a reduced risk of ovarian cancer but also of breast cancer (around 50% for breast cancer). Patients with Lynch syndrome are at high risk of endometrial cancer, and prophylactic hysterectomy may be proposed to women for whom surgery is indicated for a uterine disorder (fibroma). Prophylactic surgery may be proposed to patients at risk of hereditary gastrointestinal malignancies, either on a case-by-case basis (Lynch syndrome) or more systematically for patients with the familial adenomatous polyposis syndrome or hereditary diffuse gastric cancer. Despite its efficacy, prophylactic surgery in a healthy individual, albeit at high risk of cancer, remains a difficult, multidisciplinary decision. Psychological support is needed to anticipate the possible physical, psychological and social complications - and benefits. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hereditary tumor (surgery) neoplasm (prevention) primary prevention EMTREE MEDICAL INDEX TERMS abdominal surgery article breast tumor (prevention) colon polyposis (surgery) female genetics hereditary nonpolyposis colorectal cancer (surgery) human hysterectomy male mastectomy methodology ovariectomy ovary tumor (prevention) risk reduction stomach tumor (surgery) tumor gene uterus cancer (prevention) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French MEDLINE PMID 23815011 (http://www.ncbi.nlm.nih.gov/pubmed/23815011) PUI L369085180 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 277 TITLE Trade-offs associated with axillary lymph node dissection: Implications of the eligibility versus enrollment in ACOSOG Z0011 AUTHOR NAMES Krishnan M.S. Recht A. Bellon J.R. Punglia R.S. AUTHOR ADDRESSES (Krishnan M.S.; Recht A.; Bellon J.R.; Punglia R.S.) Harvard Radiation Oncology Program, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA CORRESPONDENCE ADDRESS M.S. Krishnan, SOURCE Journal of Clinical Oncology (2012) 30:27 SUPPL. 1. Date of Publication: 20 Sep 2012 CONFERENCE NAME 2012 Breast Cancer Symposium CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-09-13 to 2012-09-15 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Results from ACOSOG Z0011 suggest that axillary lymph node dissection (ALND) may not be necessary for patients following positive sentinel lymph node biopsy (SLNB). Concerns have been raised regarding the generalizability of this trial, given the low-risk patient population. It is uncertain whether a subgroup who would have been eligible for ACOSOG Z0011 but were not adequately represented in the study may still benefit from ALND. Methods: We constructed a decision analysis using a Monte Carlo model to simulate axillary recurrence (ALR) risk, lymphedema, and quality of life of women age 45, 55, and 75 y/o with stage II cancers following breast conserving surgery (BCS) with positive SLNB who were then treated with either ALND and whole-breast radiation (BRT) or BRT alone. Women were divided into two risk groups: those with a risk of residual nodal involvement of 30-60% (high risk); and those with a risk less than 30% (low risk, similar to the Z0011 patients). Probabilities and utilities for health states were derived from previous studies. Results: BRT alone resulted in improved quality-adjusted life expectancy (QALE) in the low-risk group, while ALND with BRT resulted in improved QALE in the high-risk group. Overall survival (OS) was similar at 5 years with both treatment strategies in both groups but was superior with ALND at 20 years in the high risk group (Table). Differences in outcomes decreased with increasing age. In the low-risk group, sensitivity analysis showed BRT alone is preferred unless the ALR risk with BRT is greater than 1.6% or the lymphedema risk with ALND is less than 10%. In the high-risk group, ALND with BRT is the preferred strategy unless the ALR risk with BRT is less than 2.3%. Conclusions: Patients who would have been eligible for ACOSOG Z0011 but are at higher risk of having residual nodal disease following BCS and positive SLNB may benefit from ALND plus BRT rather than BRT alone. (Table presented) . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axillary lymph node breast cancer lymph node dissection EMTREE MEDICAL INDEX TERMS breast female health status high risk population human life expectancy low risk population lymphedema Monte Carlo method neoplasm overall survival partial mastectomy patient population quality of life radiation recurrence risk risk sensitivity analysis sentinel lymph node biopsy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71086103 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 278 TITLE Development of patients' decision aid for older women with stage i breast cancer considering radiotherapy after lumpectomy AUTHOR NAMES Wong J. D'Alimonte L. Angus J. Paszat L. Metcalfe K. Whelan T. Llewellyn-Thomas H. Warner E. Franssen E. Szumacher E. AUTHOR ADDRESSES (Wong J.; Paszat L.; Warner E.; Szumacher E., Ewa.Szumacher@sunnybrook.ca) Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. (D'Alimonte L.) Department of Radiation Therapy, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada. (Angus J.; Metcalfe K.) Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. (Franssen E.) Consultant Statistician, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. (Whelan T.) Department of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada. (Llewellyn-Thomas H.) Department of Community and Family Medicine, Center of Informed Choice, Dartmouth Medical School, Lebanon, NH, United States. CORRESPONDENCE ADDRESS E. Szumacher, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Email: Ewa.Szumacher@sunnybrook.ca SOURCE International Journal of Radiation Oncology Biology Physics (2012) 84:1 (30-38). Date of Publication: 1 Sep 2012 ISSN 0360-3016 1879-355X (electronic) BOOK PUBLISHER Elsevier Inc., 360 Park Avenue South, New York, United States. ABSTRACT Purpose: To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. Methods and Materials: A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. Results: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. Conclusions: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options. © 2012 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer radiotherapy estrogen receptor positive breast cancer (radiotherapy, surgery) medical decision making partial mastectomy patient decision aid progesterone receptor breast cancer (radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS article cancer hormone therapy cancer patient cancer staging emotional stress human knowledge patient satisfaction priority journal EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012517430 MEDLINE PMID 22331002 (http://www.ncbi.nlm.nih.gov/pubmed/22331002) PUI L51857888 DOI 10.1016/j.ijrobp.2011.11.028 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2011.11.028 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 279 TITLE Cancer survivors and the patient-centered medical home AUTHOR NAMES Hudson S.V. Miller S.M. Hemler J. McClinton A. Oeffinger K.C. Tallia A. Crabtree B.F. AUTHOR ADDRESSES (Hudson S.V., hudsonsh@umdnj.edu; Hemler J.; McClinton A.; Tallia A.; Crabtree B.F.) The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903-2681, United States. (Hudson S.V., hudsonsh@umdnj.edu; Tallia A.; Crabtree B.F.) Department of Family Medicine and Community Health, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, United States. (Miller S.M.) Psychosocial and Biobehavioral Medicine Department, Fox Chase Cancer Center, Philadelphia, PA, United States. (Oeffinger K.C.) Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. CORRESPONDENCE ADDRESS S. V. Hudson, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08903-2681, United States. Email: hudsonsh@umdnj.edu SOURCE Translational Behavioral Medicine (2012) 2:3 (322-331). Date of Publication: September 2012 ISSN 1869-6716 1613-9860 (electronic) BOOK PUBLISHER Springer New York, 233 Spring Street, New York, United States. ABSTRACT Survivor care plans have been described as useful tools for enhancing the quality of follow-up care that cancer survivors receive after their active treatment has been completed. The relative success of current survivor care plan models is strongly dependent on the actions of individual patients. In this qualitative study of 33 cancer survivors, we explored patients' understanding of follow-up care and their motivations and resources for seeking care. Three types of survivor experiences were identified from narratives of patients treated in community oncology and National Cancer Institute-designated comprehensive cancer centers, ranging from nonactivated patients who need enhanced health care communication and decision support to navigate their care to highly activated patients adept at navigating complex health care settings. Using the patient-centered medical home as a conceptual framework, we propose a research, policy, and practice agenda that advocates for multifaceted decision support to enhance cancer survivorship and follow-up care. © 2012 Society of Behavioral Medicine. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer survivor health care facility Patient Centered Medical Home EMTREE MEDICAL INDEX TERMS adult aged article breast cancer cancer center clinical article clinical practice decision support system female follow up health care policy help seeking behavior human interpersonal communication male national health organization patient care priority journal prostate cancer qualitative analysis EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012538017 PUI L365624864 DOI 10.1007/s13142-012-0138-3 FULL TEXT LINK http://dx.doi.org/10.1007/s13142-012-0138-3 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 280 TITLE Information desire of patients with advanced cancer AUTHOR NAMES Oostendorp L. Ottevanger P.B. Van Der Graaf W.T.A. Stalmeier P.F.M. AUTHOR ADDRESSES (Oostendorp L.; Stalmeier P.F.M.) Epidemiology, Biostatistics, and Hta, Radboud University, Nijmegen Medical Center, Nijmegen, Netherlands. (Ottevanger P.B.; Van Der Graaf W.T.A.) Medical Oncology, Radboud University, Nijmegen Medical Center, Nijmegen, Netherlands. CORRESPONDENCE ADDRESS L. Oostendorp, Epidemiology, Biostatistics, and Hta, Radboud University, Nijmegen Medical Center, Nijmegen, Netherlands. SOURCE Annals of Oncology (2012) 23 SUPPL. 9 (ix475-ix476). Date of Publication: September 2012 CONFERENCE NAME 37th ESMO Congress CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-09-28 to 2012-10-02 ISSN 0923-7534 BOOK PUBLISHER Oxford University Press ABSTRACT Background: Studies on information desire of patients with cancer are typically performed in the curative setting or involve hypothetical decisions. In this study, we investigate the information desire of patients with advanced cancer at the point of decision making. Methods: 77 patients with advanced colorectal or breast cancer were included in this prospective study and filled in a questionnaire on sociodemographic data, well-being measures, and psychological measures, believed to be associated with information desire. Patients were faced with the decision whether or not to pursue second-line palliative chemotherapy. The oncologist provided the usual treatment-related information and made a substitute judgment of the patient's information desire. A nurse administered a decision aid with additional information on adverse events, tumour response, and survival. For each item, the nurse asked the patient whether the information was desired and whether it had been disclosed by the oncologist. Logistic regression analysis was performed to explore factors associated with information desire. Results: Median age was 62 years (range 32-80), 38% of patients were male, and 28% had college education or higher. Oncologists judged that information on adverse events, tumour response, and survival would be desired by 100%, 97%, and 80% of patients. The information on these items in the decision aid was desired by 95%, 91%, and 74% of patients. The question of whether the doctor had disclosed the information was answered positively by 72%, 53%, and 28% of patients. Results of the association between patient's information desire and demographic, clinical, and psychological measures will be presented. Conclusions: Even in this advanced setting, most patients accepted all information in the decision aid. Patients perceived that the oncologists had not disclosed all desired information. While oncologists accurately judged that patients in this study had a high information desire, their judgment of information desire on tumour response and survival for an individual patient was no better than could be expected by chance. These results demonstrate the importance of ascertaining a patient's information desire, and communicating more candid, especially on survival. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) advanced cancer human patient EMTREE MEDICAL INDEX TERMS breast cancer chemotherapy college decision making education logistic regression analysis male neoplasm nurse oncologist patient information physician prospective study questionnaire survival wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71782837 DOI 10.1093/annonc/mds413 FULL TEXT LINK http://dx.doi.org/10.1093/annonc/mds413 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 281 TITLE A safe approach to sparing the rectus muscle in abdominal-based microvascular breast reconstruction-TRAM, MS-TRAM, DIEP or SIEA? AUTHOR NAMES Adamthwaite J. Wilson A.D.H. James S. Searle A. Harris P. AUTHOR ADDRESSES (Adamthwaite J.; Wilson A.D.H., a.wilson@doctors.org.uk; James S.; Searle A.; Harris P.) Department of Plastic and Reconstructive Surgery, Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom. (Wilson A.D.H., a.wilson@doctors.org.uk) Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter NHS FT, Barrack Road, EX2 5DW, Devon, United Kingdom. CORRESPONDENCE ADDRESS A.D.H. Wilson, Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter NHS FT, Barrack Road, EX2 5DW, Devon, United Kingdom. Email: a.wilson@doctors.org.uk SOURCE European Journal of Plastic Surgery (2012) 35:9 (653-661). Date of Publication: September 2012 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT There has been an international drive towards the use of abdominal-based perforator (deep inferior epigastric perforator (DIEP) or superficial inferior epigastric artery (SIEA)) flaps for breast reconstruction as they provide the ideal tissue whilst minimizing donor site morbidity, postoperative pain and recovery times. Ultimately, what is desired is a safe and reliable reconstruction. We retrospectively reviewed 245 consecutive abdominal-based free flaps performed by three surgeons at a single institution between January 2002 and March 2008. Primary breast reconstructions were planned as DIEPs, but a safe, flexible approach to flap selection was adopted with the most appropriate flap performed depending on the perforator anatomy at the time of surgery. Chest wall resurfacing procedures for extensive recurrent disease, inflammatory breast carcinoma or following radionecrosis were planned as transverse rectus abdominis myocutaneous (TRAM) flaps. The incidence of flap complications was compared including total and partial flap loss, returns to operating room, seroma, abdominal hernia/ bulge, fat necrosis and delayed wound healing. Patient age, body mass index (BMI), smoking status, co-morbidity and pre- and post-operative radiotherapy were recorded. Two hundred patients, mean age 48 years (range, 26-74 years), underwent a total of 245 abdominal-based microvascular breast reconstructions. Twelve salvage TRAM flaps were performed for chest wall resurfacing. Of the remaining 233 flaps, 151 (65%) were immediate and 82 (35%) were delayed reconstructions. Flaps included 171 DIEPs, 38 muscle-sparing (MS)-TRAMs, 2 TRAMs and 22 SIEA flaps. Of the 233 reconstructions, 39 flaps (16.7%) in 31 patients received radiotherapy. Mean follow-up was 2.6 years. There were three (1.3%) complete flap losses and three (1.3%) partial flap losses. Rates of fat necrosis were 3.0% and abdominal hernia/bulge 1.7%. We present an algorithm to aid decision-making in autologous breast reconstruction that reflects our safe flexible approach.We have achieved excellent success rates in autologous breast reconstruction and conclude that in order to minimize complications, a safe flexible approach towards muscle harvest must be maintained in our drive to use perforator flaps. © Springer-Verlag 2012. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS abdominal bulge (complication) abdominal wall hernia (complication) adult aged article body mass cancer chemotherapy cancer radiotherapy cancer recurrence cancer surgery comorbidity debridement deep inferior epigastric perforator flap fat necrosis (complication) female follow up graft failure (complication) graft necrosis (complication) human inflammatory breast cancer (drug therapy, radiotherapy, surgery) major clinical study pneumothorax (complication) postoperative care preoperative radiotherapy priority journal radiation necrosis (complication) retrospective study seroma (complication) smoking superficial inferior epigastric artery flap transverse rectus abdominis musculocutaneous flap wound healing impairment (complication, surgery) wound infection (complication) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012569834 PUI L51796107 DOI 10.1007/s00238-011-0667-x FULL TEXT LINK http://dx.doi.org/10.1007/s00238-011-0667-x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 282 TITLE Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery AUTHOR NAMES Albert J.M. Liu D.D. Shen Y. Pan I.-W. Shih Y.-C.T. Hoffman K.E. Buchholz T.A. Giordano S.H. Smith B.D. AUTHOR ADDRESSES (Albert J.M.; Liu D.D.; Shen Y.; Hoffman K.E.; Buchholz T.A.; Giordano S.H.; Smith B.D., bsmith3@mdanderson.org) Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States. (Pan I.-W.; Shih Y.-C.T.) University of Chicago, Chicago, IL, United States. CORRESPONDENCE ADDRESS B.D. Smith, Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States. Email: bsmith3@mdanderson.org SOURCE Journal of Clinical Oncology (2012) 30:23 (2837-2843). Date of Publication: 2012 ISSN 0732-183X 1527-7755 (electronic) BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: The role of radiation therapy (RT) after conservative surgery (CS) remains controversial for older patients with breast cancer. Guidelines based on recent clinical trials have suggested that RT may be omitted in selected patients with favorable disease. However, it is not known whether this recommendation should extend to other older women. Accordingly, we developed a nomogram to predict the likelihood of long-term breast preservation with and without RT. Methods: We used Surveillance, Epidemiology, and End Results-Medicare data to identify 16,092 women age 66 to 79 years treated with CS between 1992 and 2002, using claims to identify receipt of RT and subsequent mastectomy. Time to mastectomy was estimated using the Kaplan-Meier method. Cox proportional hazards models determined the effect of covariates on mastectomy-free survival (MFS). A nomogram was developed to predict 5- and 10-year MFS, given associated risk factors, and bootstrap validation was performed. Results: With a median follow-up of 7.2 years, the overall 5- and 10-year MFS rates were 98.1% (95% CI, 97.8% to 98.3%) and 95.4% (95% CI, 94.9% to 95.8%), respectively. In multivariate analysis, age, race, tumor size, estrogen receptor status, and receipt of RT were predictive of time to mastectomy and were incorporated into the nomogram. Nodal status was also included given a significant interaction with RT. The resulting nomogram demonstrated good accuracy in predicting MFS, with a bootstrap-corrected concordance index of 0.66. Conclusion: This clinically useful tool predicts 5- and 10-year MFS among older women with early breast cancer using readily available clinicopathologic factors and can aid individualized clinical decision making by estimating predicted benefit from RT. © 2012 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) cancer radiotherapy cancer surgery nomogram EMTREE MEDICAL INDEX TERMS accuracy aged article cancer registry cancer size cancer survival conservative treatment female follow up human internal validity lymph node metastasis major clinical study mastectomy medicare multimodality cancer therapy overall survival predictive value priority journal race risk benefit analysis EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012482644 MEDLINE PMID 22734034 (http://www.ncbi.nlm.nih.gov/pubmed/22734034) PUI L365450297 DOI 10.1200/JCO.2011.41.0076 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2011.41.0076 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 283 TITLE Increasing readiness to decide and strengthening behavioral intentions: Evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www.bresdex.com) AUTHOR NAMES Sivell S. Edwards A. Manstead A.S.R. Reed M.W.R. Caldon L. Collins K. Clements A. Elwyn G. AUTHOR ADDRESSES (Sivell S., sivells2@cardiff.ac.uk) Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom. (Edwards A.; Elwyn G.) Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom. (Manstead A.S.R.) School of Psychology, Cardiff University, Cardiff, United Kingdom. (Reed M.W.R.; Caldon L.) Department of Oncology, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom. (Collins K.) Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, United Kingdom. (Clements A.) Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. CORRESPONDENCE ADDRESS S. Sivell, Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom. Email: sivells2@cardiff.ac.uk SOURCE Patient Education and Counseling (2012) 88:2 (209-217). Date of Publication: August 2012 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objectives: To undertake a quantitative evaluation of a theory-based, interactive online decision aid (BresDex) to support women choosing surgery for early breast cancer (Stage I and II), based on observations of its use in practice. Methods: Observational cohort study. Website log-files collected data on the use of BresDex. Online questionnaires assessed knowledge about breast cancer and treatment options, degree to which women were deliberating about their options, and surgery intentions, pre- and post-BresDex. Results: Readiness to make a decision significantly increased after using BresDex (p<.001), although there was no significant improvement in knowledge. Participants that were 'less ready' to make a decision before using BresDex, spent a longer time using BresDex (p<.05). Significant associations between surgery intentions and choices were observed (p<.001), with the majority of participants going on to have BCS. Greater length of time spent on BresDex was associated with stronger intentions to have BCS (p<.05). Conclusion: The use of BresDex appears to facilitate readiness to make a decision for surgery, helping to strengthen surgery intentions. Practice implications: BresDex may prove a useful adjunct to the support provided by the clinical team for women facing surgery for early breast cancer. © 2012 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer therapy online analysis patient decision making EMTREE MEDICAL INDEX TERMS adult aged article cancer surgery clinical practice cohort analysis early cancer female human Internet major clinical study observational study partial mastectomy patient education patient preference priority journal quantitative study questionnaire EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012444435 MEDLINE PMID 22541508 (http://www.ncbi.nlm.nih.gov/pubmed/22541508) PUI L51980687 DOI 10.1016/j.pec.2012.03.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2012.03.012 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 284 TITLE Equal opportunity disease: Men can get breast cancer, and blood clots too!! AUTHOR NAMES Prakash B. Salzman S.H. AUTHOR ADDRESSES (Prakash B.; Salzman S.H.) Winthrop University Hospital, Mineola, United States. CORRESPONDENCE ADDRESS B. Prakash, Winthrop University Hospital, Mineola, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Introduction: Tamoxifen has been found to increase the risk of venous thromboembolism (VTE), which might be further increased in patients with inherited thrombophilic conditions like Factor V Leiden mutation (FVL). We describe a case of a male patient with heterozygous FVL who developed pulmonary embolism on tamoxifen. Case report: 59-year-old male with heterozygous FVL with no prior history of VTE presented to the emergency room complaining of shortness of breath for five days. His past medical history was positive for breast cancer treated with mastectomy, chemotherapy and radiation, currently on hormonal therapy using tamoxifen. The patient had sudden onset back and right shoulder pain with difficulty breathing and leg cramps. Computerized tomography pulmonary angiogram demonstrated clots along the right pulmonary artery circulation and right lower extremity deep vein thrombus. He was anticoagulated with intravenous heparin. Thrombolytic therapy was not initiated as he was hemodynamically stable. The patient's symptoms improved and he was discharged home on warfarin and he discontinued tamoxifen. Discussion: Tamoxifen, a selective estrogen receptor modulator, is widely used in treatment and prevention of breast cancer. Tamoxifen has been found to increase the risk of VTE. FVL is the most common inherited risk factor for VTE (heterozygous and homozygous patients have a seven-fold and 80-fold increase in risk for VTE, respectively). Surprisingly in the International Breast cancer Intervention Study (IBIS-I), none of the women on tamoxifen who developed VTE were carriers of this mutation. However, writing for 34 Cancer and Leukemia Group B institutions, Garber et al found that among women taking adjuvant tamoxifen therapy for early-stage breast cancer, those who had a VTE were nearly five times more likely to have a FVL mutation than those who did not have a VTE. VTE in our male patient raises several issues: a) Like female patients, men with breast cancer may be at increased risk for VTE when treated with tamoxifen. b) Alternative hormonal therapy for breast cancer should be considered in patients with FVL mutation even without previous history of VTE. c) In patients with inherited thrombophilia, studies to address the possible role of prophylactic anticoagulation or antiplatelet agents during the period of treatment with tamoxifen would be helpful. d) Currently, an individualized risk-benefit analysis should guide decisions about prophylactic anticoagulation-antiplatelet therapy in this clinical circumstance or avoidance of tamoxifen with FVL. EMTREE DRUG INDEX TERMS adjuvant antithrombocytic agent blood clotting factor 5 Leiden heparin selective estrogen receptor modulator tamoxifen warfarin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American blood clot breast cancer human male society EMTREE MEDICAL INDEX TERMS anticoagulation case report chemotherapy computer assisted tomography dyspnea emergency ward female fibrinolytic therapy hormonal therapy intervention study leg leg cramp leukemia lung embolism mastectomy medical history mutation neoplasm patient prevention pulmonary artery radiation risk risk benefit analysis risk factor shoulder pain therapy thrombophilia vein embolism venous thromboembolism writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71993346 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 285 TITLE Factors associated with residual disease after initial breast-conserving surgery for ductal carcinoma in situ AUTHOR NAMES Wei S. Kragel C.P. Zhang K. Hameed O. AUTHOR ADDRESSES (Wei S., swei@uab.edu; Kragel C.P.; Hameed O.) Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249-7331, United States. (Zhang K.) Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249-7331, United States. (Hameed O.) Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States. CORRESPONDENCE ADDRESS S. Wei, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249-7331, United States. Email: swei@uab.edu SOURCE Human Pathology (2012) 43:7 (986-993). Date of Publication: July 2012 ISSN 0046-8177 1532-8392 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Breast-conserving surgery with radiation therapy has become a standard treatment option in women with localized ductal carcinoma in situ. Re-excision is common in breast-conserving surgery, partly due to lack of consensus on what might constitute an adequate margin. In this study, we aimed to identify potential predictive factors for presence/absence of residual disease after initial breast-conserving surgery. Of 232 cases with a diagnosis of ductal carcinoma in situ without invasive carcinoma at initial biopsy between 2005 and 2009, 108 patients underwent breast-conserving surgery, of which 46 had re-excisions due to close margins (≤2 mm). The notable features significantly associated with ductal carcinoma in situ residuum (19/46; 41%) on univariate logistic regression analysis included the number of close margins, the percentage of sections with ductal carcinoma in situ, and the number of duct spaces with ductal carcinoma in situ (no. of ductal carcinoma in situ ducts) at close margins. Only the percentage of sections with ductal carcinoma in situ remained a significant factor associated with outcomes on multivariate analysis, whereas the number of ductal carcinoma in situ ducts at close margins held borderline predictive value (P = .054). Furthermore, logistic regression and classification and regression tree analysis using the 10-fold cross validation method revealed optimal predicting accuracy by using the 3 significant factors in univariate analysis. The final decision tree was constructed by using the number of ductal carcinoma in situ ducts at close margins and the percentage of sections with ductal carcinoma in situ. Thus, these 2 factors represent the most powerful predictors for residual disease on re-excision. Optimal discriminatory power for prediction of absence of residual disease was achieved with cutoffs of 18 ductal carcinoma in situ ducts at close margins and 51.3% sections with ductal carcinoma in situ. © 2012 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intraductal carcinoma (surgery) partial mastectomy EMTREE MEDICAL INDEX TERMS accuracy adult aged article human major clinical study minimal residual disease EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012349175 MEDLINE PMID 22221704 (http://www.ncbi.nlm.nih.gov/pubmed/22221704) PUI L51794768 DOI 10.1016/j.humpath.2011.09.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.humpath.2011.09.010 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 286 TITLE BresDex: Helping women make breast cancer surgery choices AUTHOR NAMES Jones B. AUTHOR ADDRESSES (Jones B., bolette.jones@wales.nhs.uk) Department of Photography, Media Resources Centre, University Hospital Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. CORRESPONDENCE ADDRESS B. Jones, Department of Photography, Media Resources Centre, University Hospital Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. Email: bolette.jones@wales.nhs.uk SOURCE Journal of Visual Communication in Medicine (2012) 35:2 (59-64). Date of Publication: June 2012 ISSN 1745-3054 1745-3062 (electronic) BOOK PUBLISHER Informa Healthcare, 69-77 Paul Street, London, United Kingdom. ABSTRACT Women diagnosed with early breast cancer face a difficult decision between mastectomy and breast conservation surgery with radiotherapy. BresDex is an interactive decision-making support tool, designed to go together with the assistance and information these women currently receive, to help them in making the right choices. This paper will discuss the concepts behind this decision-making tool, the development of the project and the role of clinical photography within it. © 2012 The Institute of Medical Illustrators. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision making mastectomy partial mastectomy women's health EMTREE MEDICAL INDEX TERMS article decision support system female human patient satisfaction psychological aspect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22747264 (http://www.ncbi.nlm.nih.gov/pubmed/22747264) PUI L365164402 DOI 10.3109/17453054.2012.690132 FULL TEXT LINK http://dx.doi.org/10.3109/17453054.2012.690132 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 287 TITLE The involvement of partners in breast cancer treatment decision making AUTHOR NAMES Hawley S.T. Janz N.K. Lillie S.E. Schwartz K.L. Graff J. Hamilton A.S. Katz S.J. AUTHOR ADDRESSES (Hawley S.T.; Janz N.K.; Lillie S.E.; Schwartz K.L.; Graff J.; Hamilton A.S.; Katz S.J.) University of Michigan, Ann Arbor, MI USA; University of Michigan School of Public Health, Ann Arbor, MI USA; Karmanos Cancer Institute Division of Population Studies and Disparities Research, Wayne State University Department of Family Medicine and Public Health Sciences, Detroit, MI USA; New Jersey State Cancer Registry, New Brunswick, NJ; University of Southern California, Los Angeles, CA USA; University of Michigan Medical School, Ann Arbor, MI USA CORRESPONDENCE ADDRESS S.T. Hawley, SOURCE Journal of Clinical Oncology (2012) 30:15 SUPPL. 1. Date of Publication: 20 May 2012 CONFERENCE NAME 2012 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-06-01 to 2012-06-05 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Incorporating partners into treatment decision making is an important element of patient-centered care, yet little is known about the role of partners in the decision process. Methods: We surveyed 503 partners of a population-based sample of breast cancer survivor 4 years after diagnosis (RR= 76%, N=382).The outcome was partners' reports of decision regret. Independent variables included decision making process measures (partners' reports of sufficient treatment information receipt and sufficient involvement in decision making), race/ethnicity, age, education and income. Multivariable logistic regression was used to assess associations between decision regret and race/ethnicity, controlling for other variables. Results: 49% of partners were white, 14% African American, 15% more-acculturated Latino, and 18% less-acculturated Latino. One quarter (26%) of partners reported that they received insufficient information and one third (35%) desired more involvement in decision-making. Compared to whites, less-acculturated Latino partners more often reported that they received insufficient information (41% vs. 18%, p<0.05) and desired more involvement in decision-making (49% vs. 14%, p<0.001). Overall 30% of partners reported high decision regret. Multivariate analyses showed factors associated with high decision regret were less-acculturated Latinos, insufficient information receipt and desire for more involvement (Table). Conclusions: Most partners of breast cancer survivors reported low decision regret and positively appraised their involvement in the decision process. Less acculturated Latinos reported more dissatisfaction with the decision process. Findings suggest the need for culturally appropriate treatment decision support interventions that include partners. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer therapy decision making oncology society EMTREE MEDICAL INDEX TERMS African American cancer survivor decision support system diagnosis education Hispanic human income independent variable logistic regression analysis multivariate analysis patient care population LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71004295 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 288 TITLE Predictors of recurrence in postmastectomy patients with one to three positive lymph nodes AUTHOR NAMES Moo T.-A. McMillan R. Lee M. Stempel M. Patil S. Ho A.Y. Mahmoud E.-T. AUTHOR ADDRESSES (Moo T.-A.; McMillan R.; Lee M.; Stempel M.; Patil S.; Ho A.Y.; Mahmoud E.-T.) New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY USA; Memorial Sloan-Kettering Cancer Center, New York, NY USA CORRESPONDENCE ADDRESS T.-A. Moo, SOURCE Journal of Clinical Oncology (2012) 30:15 SUPPL. 1. Date of Publication: 20 May 2012 CONFERENCE NAME 2012 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-06-01 to 2012-06-05 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Although the role of post mastectomy radiation therapy (PMRT) is well established in women with ≥ 4 positive axillary lymph nodes (ALN), its indications in patients with 1-3 positive ALN is controversial. A recent large meta-analysis suggested a survival benefit in patients with 1-3 positive ALN who received PMRT. However, because recurrence rates in this group are low, identifying a subgroup of patients at higher risk for locoregional recurrence (LRR) could aid decision-making about PMRT. Methods: From an institutional database, 1,333 breast cancer patients who underwent mastectomy between 1996 and 2006 and had 1-3 positive ALN were identified. Among these, T3/T4 tumors and those who received PMRT were excluded. 926 patients were analyzed. The Kaplan-Meier method and Cox regression was used to explore clinicopathologic features that predicted LRR, distant metastases (DM), and recurrence-free survival (RFR). Results: Median follow-up was 7yrs. LRR occurred in 49 patients and DM in 126 patients. LRR and/or DM occurred in 146. On univariate analysis, factors significantly affecting LRR recurrence were increasing tumor size (p=0.04), age <50 (p=0.003), histologic grade (p=0.03), nuclear grade (p=0.008), lymphovascular invasion (LVI) (p<0.0001), and macroscopic ALN metastases (p=0.02). On multivariate analysis, age <50 (p=0.0012) and the presence of LVI (p<0.0001) predicted a higher LRR; increasing tumor size (p=0.0005), age <50 (p=0.04), higher histologic grade (p=0.01), number of positive ALN (p=0.04), LVI (p=0.02), macroscopic ALN metastases (p=0.02), and no chemotherapy (p=0.02) predicted a significantly lower RFR. Conclusions: Pts with T1-2 tumors and 1-3 positive ALN are at low risk of isolated LRR; however, patients <50 and with LVI may have additional risk that warrants consideration of PMRT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human lymph node oncology patient society EMTREE MEDICAL INDEX TERMS axillary lymph node breast cancer cancer patient chemotherapy data base decision making distant metastasis female follow up Kaplan Meier method lymph vessel metastasis mastectomy meta analysis metastasis multivariate analysis neoplasm proportional hazards model radiotherapy recurrence free survival recurrence risk risk survival tumor volume univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71003211 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 289 TITLE Trade-offs associated with axillary lymph node dissection: Implications of the eligibility versus enrollment in ACOSOG Z0011 AUTHOR NAMES Krishnan M.S. Recht A. Bellon J.R. Punglia R.S. AUTHOR ADDRESSES (Krishnan M.S.; Recht A.; Bellon J.R.; Punglia R.S.) Harvard Radiation Oncology Program, Boston, MA USA; Beth Israel Deaconess Medical Center, Boston, MA USA; Dana-Farber Cancer Institute, Boston, MA USA CORRESPONDENCE ADDRESS M.S. Krishnan, SOURCE Journal of Clinical Oncology (2012) 30:15 SUPPL. 1. Date of Publication: 20 May 2012 CONFERENCE NAME 2012 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-06-01 to 2012-06-05 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Results from ACOSOG Z0011 suggest axillary lymph node dissection (ALND) may not be necessary for patients following positive sentinel lymph node biopsy (SLNB). Concerns have been raised regarding generalizability of this trial, given the low-risk patient population. It is uncertain whether a subgroup who would have been eligible for ACOSOG Z0011 but were not adequately represented in the study may still benefit from ALND. Methods: We constructed a decision analysis using a Monte Carlo model to simulate axillary recurrence risk, lymphedema, and quality of life of women aged 45, 55 and 75 y/o with Stage II cancers following breast conserving surgery (BCS) with positive SLNB who were then treated with ALND and whole-breast radiation (BRT) or BRT alone. Women were divided into two risk groups based on the Memorial Sloan-Kettering Cancer Center non-sentinel lymph node (NSLN) nomogram: those with risk of residual nodal involvement of 30-60% (high risk); and those with risk less than 30% (low risk, similar to the Z0011 patients). Probabilities and utilities for health states were derived from prior studies. Results: BRT alone resulted in improved quality-adjusted life expectancy (QALE) in the low-risk group, while ALND with BRT resulted in improved QALE in the high-risk group. Overall survival (OS) was similar at 5 years with both treatment strategies in both groups but was superior with ALND at 20 years in the high risk group (Table). Differences in outcomes decreased with increasing age. In the low-risk group, sensitivity analysis showed BRT alone is preferred unless the axillary recurrence risk with BRT is greater than 1.6% or the lymphedema risk with ALND is less than 10%. In the high-risk group, ALND with BRT is the preferred strategy unless the axillary recurrence risk with BRT is less than 2.3%. Conclusions: Patients who would have been eligible for ACOSOG Z0011 but are at higher risk of having residual nodal disease following BCS and positive SLNB may benefit from ALND plus BRT rather than BRT alone. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axillary lymph node lymph node dissection oncology society EMTREE MEDICAL INDEX TERMS breast cancer center female health status high risk population human life expectancy low risk population lymphedema Monte Carlo method neoplasm nomogram overall survival partial mastectomy patient population quality of life radiation recurrence risk risk sensitivity analysis sentinel lymph node sentinel lymph node biopsy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71004294 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 290 TITLE Making good decisions in collaboration with patients with breast cancer: The role of decision quality measures and inconsultation decision support tools AUTHOR NAMES McGarrigle H. Lloyd A. Joseph-Williams N. Elwyn G. AUTHOR ADDRESSES (Lloyd A.; Joseph-Williams N.; Elwyn G.) Cardiff University, Cardiff, United Kingdom. (McGarrigle H.) Cardiff and Vale University Health Board, Cardiff, United Kingdom. CORRESPONDENCE ADDRESS H. McGarrigle, Cardiff and Vale University Health Board, Cardiff, United Kingdom. SOURCE European Journal of Surgical Oncology (2012) 38:5 (441). Date of Publication: May 2012 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2012 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2012-05-21 to 2012-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Cardiff and Vale Breast Care Team aims to inform and involve patients in decisions about their care and treatment. In order to assess this aim, a Decision Quality Measure (DQM) was introduced to check patients' knowledge of the key features and differences between treatment options, their readiness to decide and their preferred choice of treatment. Methods: The Breast Care Team worked in collaboration with a programme called Making Good decisions In Collaboration (MAGIC) to develop a DQM. Patients eligible for either mastectomy or lumpectomy with radiotherapy were asked to complete DQMs at two points in the clinical care pathway: The end of the diagnostic consultation (DQM1), and the end of the home visit (DQM2). Results: Between February-December 2011, 79% (n=69) of eligible patients completed DQM1 and 80% (n=55) of eligible patients completed DQM2. Data from each patients' DQM1 was used to tailor the home visit to their specific needs. Comparison of data from DQM1 and DQM2 shows considerable improvement in patients' knowledge, readiness to decide, and confidence in choice of treatment. There was also considerable improvement in patients' knowledge after a brief in-consultation decision support tool (called an Option Grid) was introduced into routine practice. Conclusion: DQMs provide data to help the Breast Care Team to monitor and assess the quality of their patients' decisions. In-consultation decision support tools can help patients to understand the key features and differences between treatment options. DQMs also provide real time data to help Breast Care Nurses to tailor support for patients making difficult decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast surgery decision support system human patient EMTREE MEDICAL INDEX TERMS breast care consultation diagnosis mastectomy nurse partial mastectomy professional practice radiotherapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70737311 DOI 10.1016/j.ejso.2012.02.117 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.02.117 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 291 TITLE Mastectomy without immediate breast reconstruction: Counselling and decision making analysis AUTHOR NAMES Cooper C. Gerald S.C.K.F. Stallard S. AUTHOR ADDRESSES (Cooper C.; Gerald S.C.K.F.; Stallard S.) Western Infirmary, Glasgow, United Kingdom. CORRESPONDENCE ADDRESS C. Cooper, Western Infirmary, Glasgow, United Kingdom. SOURCE European Journal of Surgical Oncology (2012) 38:5 (444). Date of Publication: May 2012 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2012 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2012-05-21 to 2012-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Current NICE guidelines suggest that possibility of breast reconstruction should be discussed with all patients prior to mastectomy. However, majority of patients are still treated with mastectomy only and reconstruction is not carried out. We investigated the rates of documentation of patient counselling and consequent decision making contributing to immediate reconstruction [IR] rate. Methods: 57 consecutive patients' data, was prospectively collected in a single centre for those who underwent mastectomy without reconstruction, between July 2011 and December 2011. Consultations about IR and patients' acceptance of counselling were analysed in this audit. Results: The patients mean age was 67.0 years and included 3 male breast cancers. In this group of patients undergoing mastectomy but no reconstruction, a discussion regarding reconstruction was documented in 26 (46%) of cases. 17 of these patients refused IR on consultation due to lack of interest, preference for a delayed procedure and not wanting to potentially delay adjuvant therapy. The remaining cases were advised against IR due to co-morbidities. Of the 31 patients who didn't have a discussion regarding IR documented reasons given by their consultant surgeon prospectively included male sex, comorbidities, advanced age and locally advanced cancer. Conclusions: The number of patients undergoing mastectomy not fit or suitable for reconstruction is similar in this group of patients as in a previous cohort investigated. Although there is invariably a reason that a patient is not suitable for reconstruction, documentation of any discussion or decision-making is still necessary. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery counseling decision making mastectomy EMTREE MEDICAL INDEX TERMS adjuvant therapy advanced cancer breast cancer clinical audit consultation documentation human male male breast morbidity patient procedures surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70737321 DOI 10.1016/j.ejso.2012.02.127 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.02.127 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 292 TITLE The impact of preoperative CT angiography on breast reconstruction with abdominal perforator flaps. AUTHOR NAMES Tong W.M. Dixon R. Ekis H. Halvorson E.G. AUTHOR ADDRESSES (Tong W.M.) Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. (Dixon R.; Ekis H.; Halvorson E.G.) CORRESPONDENCE ADDRESS W.M. Tong, Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. SOURCE Annals of plastic surgery (2012) 68:5 (525-530). Date of Publication: May 2012 ISSN 1536-3708 (electronic) ABSTRACT Because of the anatomic variability of the deep inferior epigastric artery, preoperative CT angiography (pCTA) has gained popularity for planning abdominal perforator flap breast reconstruction. This study evaluates how pCTA has affected preoperative planning, operative time, and outcome. We performed a retrospective study of abdominal free flap breast reconstruction at our institution over a 4-year period, with pCTA performed routinely after the first year. Operative time and outcomes were compared between procedures with and without pCTA. Incidental findings were recorded. Between 2006 and 2010, 102 abdominal perforator flap surgeries were performed on 69 patients; of whom, 51 patients had pCTA and 18 did not. pCTA changed preoperative planning in 50% of cases by identifying the best perforator in unilateral cases or perforators with long intramuscular course. Preoperative plan based on pCTA corresponded to operative procedures in 89% of cases. The sensitivity and positive predictive value of pCTA to localize perforators were 79% and 92%, respectively. Operative time was significantly reduced with pCTA for both unilateral (636 vs. 496 minutes, P = 0.017) and bilateral cases (746 vs. 629 minutes, P = 0.05). Rates of fat necrosis, partial flap necrosis, and complete flap loss were comparable between the 2 groups. Incidentalomas were found in 36% of patients. pCTA appears to reduce operative time by minimizing time spent identifying perforators, assisting in side selection for unilateral reconstruction, and optimizing planning when a long intramuscular course is identified. The effect of a learning curve cannot be excluded and is the chief limitation of this study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction epigastric artery free tissue graft multidetector computed tomography preoperative care EMTREE MEDICAL INDEX TERMS abdomen adult aged article breast tumor (surgery) decision support system evaluation study female graft survival human incidental finding mastectomy methodology middle aged predictive value radiography retrospective study sensitivity and specificity treatment outcome vascularization LANGUAGE OF ARTICLE English MEDLINE PMID 22531408 (http://www.ncbi.nlm.nih.gov/pubmed/22531408) PUI L365456095 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 293 TITLE Acupuncture for hot flashes: Decision making by breast cancer survivors AUTHOR NAMES Mao J.J. Leed R. Bowman M.A. Desai K. Bramble M. Armstrong K. Barg F. AUTHOR ADDRESSES (Mao J.J., maoj@uphs.upenn.edu; Leed R.; Bowman M.A.; Desai K.; Bramble M.) Department of Family Medicine and Community Health, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. (Mao J.J., maoj@uphs.upenn.edu) Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. (Mao J.J., maoj@uphs.upenn.edu; Armstrong K.) Abramson Cancer Center, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. (Bowman M.A.) Center for Public Health Initiatives, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. (Armstrong K.; Barg F.) Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. CORRESPONDENCE ADDRESS J.J. Mao, Department of Family Medicine and Community Health, University of Pennsylvania, School of Medicine, Philadelphia, PA, United States. Email: maoj@uphs.upenn.edu SOURCE Journal of the American Board of Family Medicine (2012) 25:3 (323-332). Date of Publication: May-June 2012 ISSN 1557-2625 1558-7118 (electronic) BOOK PUBLISHER American Board of Family Medicine, 2228 Young Drive, Lexington, United States. ABSTRACT Purpose: Hot flashes (HFs) are a particularly common and distressing symptom among breast cancer survivors (BCSs). Given its low rate of side effects, acupuncture shows promise as a therapeutic approach for HFs, but little is known about BCS's decision making about the use of acupuncture. This study seeks to identify attitudes and beliefs about using acupuncture for HFs by BCSs. Methods: Using the Theory of Planned Behavior (TPB) as a conceptual framework, we conducted semistructured interviews among women with stage I-III breast cancer who had finished primary treatment and were currently experiencing HFs. Interviews were taped, transcribed, and coded. We used a modified grounded theory approach to analyze the data. Results: Twenty-five BCSs (13 whites/12 African American) participated in the study. Respondents stated that their intended use of acupuncture for HFs would be dependent on (1) expected therapeutic effects (eg, pain relief, energy); (2) practical concerns (eg, fear of needles, practitioner experience, time commitment); and (3) source of decision support/validation (eg, family members, physicians, self). Although constructs in the TPB accounted for many decision factors, respondents identified 2 major themes outside of the TPB: (1) viewing acupuncture as a natural alternative to medications, and (2) assessing the degree of HFs as bothersome enough in the context of other medical comorbidities to trigger the need for therapy. Conclusion: BCSs expressed varied expected therapeutic benefits, practical concerns, and decision support, emphasizing the "natural appeal" and symptom appraisal as key determinants when using acupuncture for HFs. Incorporating these factors in counseling BCSs may promote patient-centered communication, leading to improved hot flash management and quality of life. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acupuncture breast cancer (drug therapy, drug therapy, radiotherapy, surgery) cancer survivor hot flush (therapy) EMTREE MEDICAL INDEX TERMS adult aged article cancer chemotherapy cancer radiotherapy cancer surgery clinical article ethnicity female human medical decision making semi structured interview Theory of Planned Behavior therapy effect EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012323680 MEDLINE PMID 22570396 (http://www.ncbi.nlm.nih.gov/pubmed/22570396) PUI L364951669 DOI 10.3122/jabfm.2012.03.110165 FULL TEXT LINK http://dx.doi.org/10.3122/jabfm.2012.03.110165 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 294 TITLE Challenges in ductal carcinoma in situ risk communication and decision-making: Report from an American Cancer Society and National Cancer Institute Workshop AUTHOR NAMES Partridge A.H. Elmore J.G. Saslow D. McCaskill-Stevens W. Schnitt S.J. AUTHOR ADDRESSES (Partridge A.H., ann_partridge@dfci.harvard.edu) Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, United States. (Elmore J.G.) Department of Medicine, University of Washington, School of Medicine, Seattle, WA, United States. (Saslow D.) Department of Breast and Gynecologic Cancer, American Cancer Society, Atlanta, GA, United States. (McCaskill-Stevens W.) Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States. (Schnitt S.J.) Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS A.H. Partridge, Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, United States. Email: ann_partridge@dfci.harvard.edu SOURCE CA Cancer Journal for Clinicians (2012) 62:3 (203-210). Date of Publication: May/June 2012 ISSN 0007-9235 1542-4863 (electronic) BOOK PUBLISHER Wiley-Blackwell, 350 Main Street, Malden, United States. ABSTRACT In September 2010, the American Cancer Society and National Cancer Institute convened a conference to review current issues in ductal carcinoma in situ (DCIS) risk communication and decision-making and to identify directions for future research. Specific topics included patient and health care provider knowledge and attitudes about DCIS and its treatment, how to explain DCIS to patients given the heterogeneity of the disease, consideration of nomenclature changes, and the usefulness of decision tools/aids. This report describes the proceedings of the workshop in the context of the current literature and discusses future directions. Evidence suggests that there is a lack of clarity about the implications and risks of a diagnosis of DCIS among patients, providers, and researchers. Research is needed to understand better the biology and mechanisms of the progression of DCIS to invasive breast cancer and the factors that predict those subtypes of DCIS that do not progress, as well as efforts to improve the communication and informed decision-making surrounding DCIS. CA Cancer J Clin 2012. © 2012 American Cancer Society. Copyright © 2012 American Cancer Society, Inc. EMTREE DRUG INDEX TERMS tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) doctor patient relation interpersonal communication intraductal carcinoma (drug therapy, diagnosis, drug therapy, radiotherapy, surgery) patient decision making EMTREE MEDICAL INDEX TERMS anxiety breast biopsy cancer diagnosis cancer growth cancer patient cancer radiotherapy cancer surgery cancer survival cohort analysis conference paper cross-sectional study distress syndrome human informed consent mastectomy nomenclature parental attitude patient safety prediction priority journal psychosocial care quality of life retrospective study social support tumor invasion CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012269037 MEDLINE PMID 22488610 (http://www.ncbi.nlm.nih.gov/pubmed/22488610) PUI L364783721 DOI 10.3322/caac.21140 FULL TEXT LINK http://dx.doi.org/10.3322/caac.21140 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 295 TITLE Adjuvant therapy in stage i carcinoma of the breast: The influence of multigene analyses and molecular phenotyping AUTHOR NAMES Schwartz G.F. Reis-Fihlo J. Pusztai L. Fentiman I.S. Holland R. Bartelink H. Rutgers E.J.T. Solin L.J. Palazzo J. AUTHOR ADDRESSES (Schwartz G.F., gordon.schwartz@jefferson.edu) Breast Care Center, Department of Surgery and Medical Oncology, Jefferson Medical College, Philadelphia, PA, United States. (Reis-Fihlo J.) Breakthrough Breast Cancer Research Center, Chester Beatty Laboratories, London, United Kingdom. (Pusztai L.) Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Fentiman I.S.) Department of Surgical Oncology, Guys Hospital, London, United Kingdom. (Holland R.) National Expert and Training Center for Breast Cancer Screening, University Hospital Nijmegen, Nijmegen, Netherlands. (Bartelink H.) Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, Netherlands. (Rutgers E.J.T.) Department of Surgery, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, Netherlands. (Solin L.J.) Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA, United States. (Palazzo J.) Department of Pathology, Jefferson Medical College, Philadelphia, PA, United States. CORRESPONDENCE ADDRESS G.F. Schwartz, Kimmel Cancer Center, Jefferson Medical College, 1100 Walnut Street, Philadelphia, PA 19107, United States. Email: gordon.schwartz@jefferson.edu SOURCE Cancer (2012) 118:8 (2031-2038). Date of Publication: 15 Apr 2012 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background: Breast Health International and the Kimmel Cancer Center of Thomas Jefferson University cosponsored a consensus conference that included an international group of experts. Methods: Since the adoption of adjuvant chemotherapy for stage I, lymph node-negative breast cancers in 1988, investigators have tried to "fine-tune" the treatment criteria. At this consensus conference, the group debated recommendations for adjuvant hormone and cytotoxic chemotherapy in stage I breast cancers. Results: Discussions during the conference addressed issues of adjuvant therapy for stage I breast cancer and the influence of multigene analyses and molecular phenotyping. The panelists discussed various demographic, morphologic, biologic, and genetic factors expressed by individual tumors and their influence on treatment decisions. Conclusions: The panel tried to create guidelines for the consideration of adjuvant treatment of these patients, including both hormone and cytotoxic regimens. They also encouraged further research into the molecular analysis of breast cancers and the introduction of clinical trials based on current data, although they concluded that it is too early to add any of those analyses into the decision-making algorithms of recommendations for the treatment of stage I breast cancer. © 2012 American Cancer Society. EMTREE DRUG INDEX TERMS aromatase inhibitor (drug combination, drug therapy) cytotoxic agent (drug therapy) epidermal growth factor receptor 2 (endogenous compound) estrogen receptor (endogenous compound) hormone (drug therapy) progesterone receptor (endogenous compound) tamoxifen (drug combination, drug therapy) trastuzumab (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (drug therapy, drug therapy, radiotherapy, surgery) cancer adjuvant therapy cancer staging genetic analysis phenotype EMTREE MEDICAL INDEX TERMS article cancer genetics cancer grading cancer morphology cancer radiotherapy cancer research cancer size consensus development demography gene expression profiling gene mutation genetic heterogeneity human local excision mastectomy medical decision making micrometastasis (complication) nuclear magnetic resonance imaging practice guideline priority journal protein analysis protein expression sentinel lymph node biopsy submicrometastasis (complication) treatment indication CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) Clinical and Experimental Biochemistry (29) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012210333 MEDLINE PMID 22392361 (http://www.ncbi.nlm.nih.gov/pubmed/22392361) PUI L51898229 DOI 10.1002/cncr.27431 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.27431 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 296 TITLE An audit of treatment focussed BRCA1/2 mutation testing at an integrated Familial Cancer Clinic AUTHOR NAMES Lewis A. Cicciarelli L. Pandey D. Lovett C.M. Driessen R. Sawyer S. Young M.A. Mitchell G. AUTHOR ADDRESSES (Lewis A.; Cicciarelli L.; Pandey D.; Lovett C.M.; Driessen R.; Sawyer S.; Young M.A.; Mitchell G.) Peter MacCallum Familial Cancer Centre, Melbourne, Australia. CORRESPONDENCE ADDRESS A. Lewis, Peter MacCallum Familial Cancer Centre, Melbourne, Australia. SOURCE Hereditary Cancer in Clinical Practice (2012) 10 SUPPL. 2. Date of Publication: 12 Apr 2012 CONFERENCE NAME Familial Aspects of Cancer 2011 Research and Practice CONFERENCE LOCATION Kingscliff, Australia CONFERENCE DATE 2011-08-23 to 2011-08-26 ISSN 1731-2302 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Background: The growth of a personalised approach to cancer treatment including surgical risk management strategies and Parp Inhibitor trials for BRCA1/2 mutation carriers has lead to the Peter MacCallum Familial Cancer Centre experiencing a rapidly increased demand for expedited risk assessment appointments +/- BRCA1/2 mutation testing. Expedited BRCA mutation screens are offered to individuals assessed eligible for publically funded testing and require these results in a defined time period to assist in their current cancer management. The demand for expedited services places a burden on both the laboratory and clinic as patients need to be seen at short notice and have their genetic test take priority over routine tests. Aim: To better understand the clinical utility and mutation detection rate of expedited BRCA1/2 tests, in order to improve services and resources for this group of patients. Methods: A retrospective review of the Peter MacCallum Familial Cancer Centre's BRCA1/2 mutation testing data from January 2007-April 2011 was performed. During this time period 119 patients were offered a treatment-focussed genetic test. The characteristics of the tested cohort were reviewed and analysed. Results: Numbers of referrals for expedited risk assessment and requests for treatment focussed BRCA1/2 mutation testing remained consistent between 2007 and 2009 although have significantly increased in 2010 with nearly a twofold increase. Most patients referred had been recently diagnosed with breast cancer and were considering the option of breast conservation versus mastectomy. To assist them with this decision they were seeking advice about their genetic risk of developing a new primary breast cancer. In addition, referrals were also received to determine the eligibility of some patients for Parp Inhibitor trials. A pathogenic mutation was detected in 20/119 (16.8per cent) of patients who had an expedited BRCA1/2 test. Further analysis about the pre and post testing treatment decisions is being analysed and will be presented. Conclusion: In 2010 a significant increase in demand for treatment focussed risk assessments and expedited BRCA1/2 tests was experienced by the Peter MacCallum Familial Cancer Centre. Further data will be presented on the characteristics of these cohorts and the clinical utility of expedited assessments. EMTREE DRUG INDEX TERMS nicotinamide adenine dinucleotide adenosine diphosphate ribosyltransferase inhibitor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer center clinical audit hereditary tumor human mutation neoplasm EMTREE MEDICAL INDEX TERMS breast breast cancer cancer therapy genetic risk hospital laboratory mastectomy patient risk assessment risk management surgical risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70928728 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 297 TITLE Working towards a more informed decision: Development of an educational tool for older breast cancer patients AUTHOR NAMES D'Alimonte L. Wong J. Paszat L. Szumacher E. AUTHOR ADDRESSES (D'Alimonte L., laura.dalimonte@sunnybrook.ca; Wong J., jen.jw.wong@gmail.com; Paszat L., lawrence.paszat@sunnybrook.ca; Szumacher E., ewa.szumacher@sunnybrook.ca) Odette Cancer Centre, Toronto, Canada. CORRESPONDENCE ADDRESS L. D'Alimonte, Odette Cancer Centre, Toronto, Canada. Email: laura.dalimonte@sunnybrook.ca SOURCE Journal of Medical Imaging and Radiation Sciences (2012) 43:1 SUPPL. 1 (S23-S24). Date of Publication: March 2012 CONFERENCE NAME 17th World Congress of the International Society of Radiographers and Radiological Technologists, ISRRT and the 70th Annual General Conference of the Canadian Association of Medical Radiation Technologists, CAMRT CONFERENCE LOCATION Toronto, ON, Canada CONFERENCE DATE 2012-06-07 to 2012-06-10 ISSN 1939-8654 BOOK PUBLISHER Elsevier ABSTRACT Purpose: To develop a patient decision aid (PtDA) for older women with stage I, ER/PR positive breast cancer considering adjuvant treatment post- lumpectomy and to examine its impact on helping patients cope with treatment decision-making. Methods and Materials: A PtDA was developed and evaluated in three steps following the Ottawa Decision Aid Framework: 1) Needs assessment (N=16); 2) Pilot I, to examine the DA's acceptability (N=12); and 3) Pilot II, a pre-test post-test (N=38) with older women with ER/PR responsive breast cancer post-lumpectomy who were receiving adjuvant RT. Measures included questionnaires to assess patient's satisfaction with the DA, patients' self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. Results: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks and side-effects tailored to their clinical profile; includes a value clarification exercise; and steps to guide them towards their own treatment decision. Based on qualitative comments and satisfaction ratings, all women felt the PtDA was helpful and informative. Compared with baseline scores, patients had a statistically significant (p < .05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the treatment benefits and risks (AMD, -10.86, CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99, CI, 2.88 to 10.28) after using the PtDA. General trends were also reported in patient's choice predisposition scores suggesting potential differences in treatment decision after PtDA use. Conclusions: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by using a tailored PtDA to help the patient be informed of their treatment options. EMTREE DRUG INDEX TERMS adjuvant methyldopa EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human radiation radiological technologist society EMTREE MEDICAL INDEX TERMS adjuvant therapy confidence interval decision making disease predisposition exercise female hospital patient needs assessment partial mastectomy patient patient satisfaction potential difference questionnaire risk satisfaction side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70694089 DOI 10.1016/j.jmir.2011.12.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.jmir.2011.12.007 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 298 TITLE Validation of katz nomogram and chagpar score for predicting likelihood of having four or more positive nodes in patients with sentinel lymph node-positive breast cancer patients AUTHOR NAMES Nadeem R. Gudur L. Saidam Z. AUTHOR ADDRESSES (Nadeem R.; Saidam Z.) East Lancashire Trust Hospitals, Department of Breast Surgery, Manchester, United Kingdom. (Gudur L.) Lancashire Teaching Hospitals NHS Foundation, Department of Cellular Pathology, Manchester, United Kingdom. CORRESPONDENCE ADDRESS R. Nadeem, East Lancashire Trust Hospitals, Department of Breast Surgery, Manchester, United Kingdom. SOURCE European Journal of Cancer (2012) 48 SUPPL. 1 (S222). Date of Publication: March 2012 CONFERENCE NAME European Breast Cancer Conference 2012, EBCC8 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: The presence of 4 or more metastatic axillary lymph nodes in breast cancer patients is considered an indication for post-mastectomy radiotherapy (PMRT) treatment to the axilla and chest wall. Immediate breast reconstruction is usually avoided if radiotherapy treatment is thought to be indicated. Predicting the occurrence of extensive axillary nodal involvement (≥4 positive nodes) would aid in making decisions regarding postmastectomy radiotherapy and immediate breast reconstruction. Two models have been introduced for predicting the likelihood of having four or more positive nodes in SLNB positive patients. In this paper we validate their accuracy in a cohort of British breast cancer population. Methods: 147 patients with 1-3 positive SLNs who underwent completion ALND were identified. Multiple pathological variables including the histological size of the SLNs metastases were analysed. Two models by Katz and Chagpar were applied to our data set. The area under the receiver-operator characteristic (ROC) curve (AUC), 95% confidence intervals and false negative and positive rates were calculated for these models. (Table presented) Results: 30/147(20.4%) patients who had ALND after positive SLNB had 4 or more metastatic axillary nodes. Conclusion: We validated two models with variable success. Chagpar score outperformed Katz nomogram contrary to the previous validation studies. Further larger studies are required to validate these models before using them in clinical practice.. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human nomogram patient sentinel lymph node EMTREE MEDICAL INDEX TERMS axilla axillary lymph node breast reconstruction clinical practice confidence interval mastectomy metastasis model population radiotherapy thorax wall validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70729693 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 299 TITLE Surgical excision of intraductal breast papilloma diagnosed on core biopsy AUTHOR NAMES Lu Q. Tan E.Y. Ho B. Chen J.J.C. Chan P.M.Y. AUTHOR ADDRESSES (Lu Q., qinghui.lu@gmail.com; Tan E.Y.; Chen J.J.C.; Chan P.M.Y.) Department of General Surgery, Tan Tock Seng Hospital, Singapore. (Ho B.) Department of Histopathology, Tan Tock Seng Hospital, Singapore. CORRESPONDENCE ADDRESS Q. Lu, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Email: qinghui.lu@gmail.com SOURCE ANZ Journal of Surgery (2012) 82:3 (168-172). Date of Publication: March 2012 ISSN 1445-1433 1445-2197 (electronic) BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Background: The need for surgical excision of benign papillary lesions diagnosed on core biopsy remains debatable. This lack of consensus arises because although there is a possibility of histological underestimation, there are as yet no reliable predictors of malignancy. We therefore aimed to evaluate the incidence of histological underestimation in our practice, and to identify factors that predict for this, in order to reduce unnecessary surgery without missing out on possible malignancy. Methods: Retrospective review of 106 patients diagnosed with a papillary lesion on percutaneous image-guided core biopsy was performed between 1 January 2005 and 31 December 2008. The presence of atypia on core biopsy and the presence of malignancy in the surgical specimen were correlated with standard clinical, radiological and pathological features. Results: Histological underestimation occurred in 15 of 81 patients (19%). Malignancy was more likely when atypia was present in the core biopsy (P= 0.04, OR 5.17). Otherwise, a final diagnosis of malignancy was not correlated with any clinical or radiological features (P > 0.05). The presence of atypia was also not correlated with any clinical or radiological features. Conclusion: In our study, 19% of patients with a benign papillary lesion diagnosed on core biopsy were found to have atypical ductal hyperplasia or malignancy following surgery. In view of this, together with the absence of reliable predictive factors for malignancy, we recommend surgical excision of all papillary lesions diagnosed on core biopsy. © 2012 Tan Tock Seng Hospital. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast papilloma (surgery) breast tumor (surgery) decision support system mastectomy EMTREE MEDICAL INDEX TERMS adult aged article evaluation study female human middle aged needle biopsy pathology retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22510128 (http://www.ncbi.nlm.nih.gov/pubmed/22510128) PUI L51821667 DOI 10.1111/j.1445-2197.2011.05969.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1445-2197.2011.05969.x COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 300 TITLE Case report-interprofessional teamwork in palliative care ORIGINAL (NON-ENGLISH) TITLE Die interprofessionelle zusammenarbeit als typisches merkmal der Palliative Care-eine Falldiskussion AUTHOR NAMES Camartin C. AUTHOR ADDRESSES (Camartin C., cristian.camartin@ksgr.ch) Kantonsspital Graubünden, Chur, Switzerland. CORRESPONDENCE ADDRESS C. Camartin, Leitender Arzt Palliative Care, Kantonsspital Graubünden, Loëstraße 170, CH - 7000 Chur, Switzerland. Email: cristian.camartin@ksgr.ch SOURCE Therapeutische Umschau (2012) 69:2 (110-113). Date of Publication: 2012 ISSN 0040-5930 BOOK PUBLISHER Verlag Hans Huber AG, Langgassstrasse 76, Postfach, 9 Bern, Switzerland. ABSTRACT Interprofessional teamwork is a characteristic feature of palliative care. Palliative Care is a subspeciality/ discipline in health care that cares for patients with a life threatening illness. The patient determines individual goals and the extent of further treatment. The team supports patients in decision making, practical advice in symptom management and composition of the future care network. The case of a 58-year-old woman suffering from metastastic breast cancer is an extraordinary example of interprofessional teamwork in palliative care. The patient was hospitalized in a palliative care unit with a malignant bowel obstruction. She underwent ileostomy and chemotherapy. She required total parenteral nutrition and was suffering from anorexia-cachexia syndrome. During her stay in the palliative care unit, her condition deterriorated. Subsequently, her needs changed and she requested to leave the hospital for some days to see her daughter's new domicile. It was by the coordinated effort of the interprofessional palliative care team that this last wish got fulfilled and she died peacefully a few days after her return to the palliative care unit. © 2012 Verlag Hans Huber, Hogrefe AG, Bern. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) palliative therapy teamwork EMTREE MEDICAL INDEX TERMS adult anorexia article breast cancer (drug therapy, therapy) cachexia cancer chemotherapy case report female health care personnel human ileostomy intestine cancer (drug therapy, surgery) intestine obstruction motivation total parenteral nutrition EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English, German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2012112260 MEDLINE PMID 22334202 (http://www.ncbi.nlm.nih.gov/pubmed/22334202) PUI L364312066 DOI 10.1024/0040-5930/a000261 FULL TEXT LINK http://dx.doi.org/10.1024/0040-5930/a000261 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 301 TITLE Online tool to guide decisions for BRCA1/2 mutation carriers AUTHOR NAMES Kurian A.W. Munoz D.F. Rust P. Schackmann E.A. Smith M. Clarke L. Mills M.A. Plevritis S.K. AUTHOR ADDRESSES (Kurian A.W.; Munoz D.F.; Schackmann E.A.; Mills M.A.; Plevritis S.K., sylvia.plevritis@stanford.edu) Department of Radiology, Stanford University School of Medicine, Lucas MRS Imaging Center, Stanford, CA, United States. (Rust P.; Smith M.; Clarke L.) Cornerstone Systems Northwest, Lynden, WA, United States. CORRESPONDENCE ADDRESS S.K. Plevritis, Department of Radiology, Stanford University School of Medicine, Lucas MRS Imaging Center, Stanford, CA, United States. Email: sylvia.plevritis@stanford.edu SOURCE Journal of Clinical Oncology (2012) 30:5 (497-506). Date of Publication: 10 Feb 2012 ISSN 0732-183X 1527-7755 (electronic) BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. A clinical decision tool could guide these complex choices. Methods: We built a Monte Carlo model for BRCA1/2 mutation carriers, simulating breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years and prophylactic mastectomy (PM) and/or prophylactic oophorectomy (PO) at various ages. Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. We adapted the model into an online tool to support shared decision making. Results: We compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To characterize patients' treatment and survivorship experiences, we reported the tumor features and treatments associated with risk-reducing interventions; for example, in most BRCA2 mutation carriers (81%), MRI screening diagnoses stage I, hormone receptor-positive breast cancers, which may not require chemotherapy. Conclusion: Cancer risk-reducing options for BRCA1/2 mutation carriers vary in their impact on cancer incidence, recommended treatments, quality of life, and survival. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu). © 2012 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE DRUG INDEX TERMS hormone receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer ovary cancer EMTREE MEDICAL INDEX TERMS adult aged article cancer incidence cancer mortality cancer risk cancer screening cancer staging cancer surgery cancer survival clinical decision making female gene mutation human information service major clinical study practice guideline priority journal quality of life EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012095178 MEDLINE PMID 22231042 (http://www.ncbi.nlm.nih.gov/pubmed/22231042) PUI L364257989 DOI 10.1200/JCO.2011.38.6060 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2011.38.6060 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 302 TITLE Impact of decision aids in a sustained implementation at a breast care center AUTHOR NAMES Belkora J.K. Volz S. Teng A.E. Moore D.H. Loth M.K. Sepucha K.R. AUTHOR ADDRESSES (Belkora J.K., jeff.belkora@ucsf.edu; Volz S.) Institute for Health Policy Studies, University of California, San Francisco, United States. (Teng A.E.; Loth M.K.) CFB Breast Care Center, University of California, San Francisco, United States. (Moore D.H.) HDF Comprehensive Cancer Center, University of California, San Francisco, United States. (Sepucha K.R.) Harvard Medical School, Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS J.K. Belkora, 3333 California Street, Suite 265, San Francisco, CA 94121, United States. Email: jeff.belkora@ucsf.edu SOURCE Patient Education and Counseling (2012) 86:2 (195-204). Date of Publication: February 2012 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: We examined the reach and impact of five decision aids (DAs) routinely distributed to breast cancer patients as part of a shared decision making demonstration project. Methods: From 2005 to 2008, we surveyed patients' change in knowledge and decisional conflict (DC) before and after their review of DAs. Using bivariate tests, we identified significant predictors of change in knowledge or decisional conflict and entered significant predictors into a multivariate regression model. Results: We distributed 1553 DAs to 1098 patients and received 549 completed surveys. The DAs were associated with increased knowledge and decreased DC. For knowledge, significant predictors of above-average change included: lower baseline knowledge and viewing the surgery decision aid. For decisional conflict, significant predictors of above-average change included: higher decisional conflict; viewing any of the early-stage cancer DAs; and Hispanic ethnicity. Conclusions: DAs used in routine care were associated with significant knowledge gains and reductions in decisional conflict. Some subsets of patients (those reporting low baseline knowledge, high DC, or Hispanic ethnicity) may benefit more than others. Practice implications: Breast cancer patients benefit overall from routine distribution of DAs. Our exploratory findings may be useful in generating hypotheses to identify target populations who would most benefit from reviewing DAs. © 2011 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast care decision support system EMTREE MEDICAL INDEX TERMS adult article cancer patient cancer staging controlled study early cancer health care planning health center Hispanic human major clinical study patient decision making priority journal professional knowledge race difference EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012056092 MEDLINE PMID 21665420 (http://www.ncbi.nlm.nih.gov/pubmed/21665420) PUI L51470562 DOI 10.1016/j.pec.2011.05.011 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2011.05.011 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 303 TITLE Family support of sexual minority women with cancer AUTHOR NAMES Paul L. Rubin L. Pitagora D. Tworecke A. AUTHOR ADDRESSES (Paul L.; Rubin L.; Pitagora D.; Tworecke A.) New School for Social Research, New York, United States. CORRESPONDENCE ADDRESS L. Paul, New School for Social Research, New York, United States. SOURCE Psycho-Oncology (2012) 21 SUPPL. 1 (72). Date of Publication: February 2012 CONFERENCE NAME 9th Annual Conference of the American Psychosocial Oncology Society, APOS CONFERENCE LOCATION Miami, FL, United States CONFERENCE DATE 2012-02-23 to 2012-02-25 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT PURPOSE: Sexual minority women, including lesbian, bisexual and queer women, may be at particular risk for breast cancer because of greater vulnerability to modifiable risk factors compared to heterosexual women. They also report higher stress associated with cancer diagnosis and treatment. Support from family can have an important impact on the experiences of women diagnosed with breast cancer and their decisions about treatment. Yet, research shows that lesbians tend to be in frequent contact, feel close to, feel at ease talking to and asking for help from fewer family members compared to heterosexual women. It is possible that this relative lack of family support may be in part responsible for lesbians' greater cancer-related stress relative to heterosexual women. This presentation is based on interviews with sexual minority women about their decision-making regarding treatment and what they shared about the quality and nature of the support they received from their families. METHODS: Sexual minority women's experiences of family support during cancer diagnosis and treatment will be described including the quality and nature of the support they received. Participants were 13 lesbian and bisexual women who had undergone single or bilateral mastectomy for treatment of breast cancer. The original aim of the study was to identify key themes in sexual minority women's experiences of decision-making about breast reconstruction. Qualitative analysis was conducted using a “theoretical” version of thematic analysis. Family support was one of the key themes that emerged from the data. RESULTS: - Consistent themes about the quality and nature of family support and its impact on the process and context of decision-making regarding treatment were identified. Themes included levels of family involvement (i.e. tangible support, emotional support, decision-making support, and patient supporting family) and negotiating family dysfunction (i.e. exacerbating existing dysfunction, creating new dysfunction, and overcoming dysfunction). CONCLUSIONS: While the methodology of the current study precludes us from drawing conclusions about sexual minority women as compared to heterosexual women, it appears that the family support of many of the women in the current study was often fraught with underlying dysfunction related to participants' sexual minority status. Participants often described that being diagnosed with and treated for cancer contributed to the exacerbation of existing family dysfunction, created new dysfunction, and sometimes helped their families to overcome dysfunction. For some of the women, support from family took the form of emotional support, tangible support (i.e. financial support, visiting participants in the hospital and tending to their physical needs), and family involvement in participants' decision-making processes. Some participants also reported supporting their families through psychoeducation about BRCA and by trying to reduce the burden that their support needs put on elderly family members. Our presentation will help APOS professionals to gain a better understanding of the influence of family support on sexual minority women's decision-making regarding cancer treatment and general experiences of cancer so that they can provide more culturally competent care to this underserved population. RESEARCH IMPLICATIONS: Further research on the efficacy of psychosocial interventions designed to increase the support of family for sexual minority women undergoing cancer diagnosis and treatment is warranted. CLINICAL IMPLICATIONS: Tailoring psychosocial interventions to lesbians has been shown to improve mental and physical health for up to a year post-intervention. The results of the present study could be used to create a treatment manual for family psychosocial interventions for sexual minority women undergoing cancer diagnosis and treatment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female human neoplasm oncology sexual minority society EMTREE MEDICAL INDEX TERMS aged bisexual female bisexuality book breast cancer breast reconstruction cancer diagnosis cancer therapy decision making financial management health heterosexual female homosexual female hospital interview mastectomy methodology patient population psychoeducation qualitative analysis risk risk factor thematic analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70664759 DOI 10.1111/j.1099-1611.2011.03029_1.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1099-1611.2011.03029_1.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 304 TITLE Communicating side effects by informing about possible benefits and harms: Effects on breast cancer patients' satisfaction, knowledge and expectations AUTHOR NAMES Nestoriuc Y. Kluge E. Schuricht F. Von Blanckenburg P. Rief W. Albert U.S. AUTHOR ADDRESSES (Nestoriuc Y.; Kluge E.; Schuricht F.; Von Blanckenburg P.; Rief W.; Albert U.S.) Philipps Universität Marburg, Klinische Psychologie, Marburg, Germany. CORRESPONDENCE ADDRESS Y. Nestoriuc, Philipps Universität Marburg, Klinische Psychologie, Marburg, Germany. SOURCE Journal of Cancer Research and Clinical Oncology (2012) 138 SUPPL. 1 (77). Date of Publication: February 2012 CONFERENCE NAME 30th German Cancer Congress CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2012-02-22 to 2012-02-25 ISSN 0171-5216 BOOK PUBLISHER Springer Verlag ABSTRACT Objective. Meeting breast cancer patients' informational needs concerning endocrine therapy is important both for treatment satisfaction and adherence. Decision aids contribute to a more patient-centered approach and engage patients in decisions about their treatment. Yet, the type of information patients receive about side effects might influence risk perception, actual development of side effects and, eventually, the drug response. This study investigates the effects of a structured patient education focussing on the side effects of endocrine therapy. Methods. In a prospective design 58 postoperative breast cancer patients (age 26 to 77, mean: 56) were investigated before and after receiving a structured patient education that was added to the standard hospital procedures. Side effect information was given in written and verbal form by psycho-oncologists and framed in the context of possible treatment benefits and harms. Baseline and post-information measures included knowledge about tumor status, satisfaction with information about treatment and expectation to experience side effects from endocrine therapy. Expectations were rated on visual analogue scales for 45 prominent side effects, including those specific for endocrine treatment. Results. The percentage of patients knowing their tumor receptor status increased from 23% to 58% after standard hospital information and, furthermore, to 90% after the additional side effect education. The structured side effect education significantly raised patients' satisfaction with information about their treatment [t(57) 09.21, p<0.001]. Patients' overall expectations about side effects decreased after the side effect education [t(57)=2.73, p<0.01]. Particularly, the expected intensity of unspecific adverse symptoms such as headache and abdominal discomfort was reduced [t(57)=3.41, p<0.001], while the expected intensity of most side effects specific to endocrine treatment such as joint pain and hot flashes remained stable. Discussion. Educating breast cancer patients about the side effects of endocrine treatment increases patients' knowledge and satisfaction with treatment information. Furthermore, specific side effect information, when framed in the context of possible benefits and harms of endocrine therapy, reduces perceived health risk by decreasing patients' expectations of treatment unspecific side effects. EMTREE DRUG INDEX TERMS receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human neoplasm satisfaction side effect EMTREE MEDICAL INDEX TERMS abdominal discomfort arthralgia drug response education headache health hazard hormonal therapy hospital hot flush oncologist patient patient education procedures risk visual analog scale LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71303916 DOI 10.1007/s00432-011-1144-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00432-011-1144-4 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 305 TITLE Patients' decision-making in radiation oncology AUTHOR NAMES Wong J. Szumacher E. AUTHOR ADDRESSES (Wong J.; Szumacher E., ewa.szumacher@sunnybrook.ca) Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. CORRESPONDENCE ADDRESS E. Szumacher, Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Email: ewa.szumacher@sunnybrook.ca SOURCE Expert Review of Pharmacoeconomics and Outcomes Research (2012) 12:1 (95-104). Date of Publication: February 2012 ISSN 1473-7167 1744-8379 (electronic) BOOK PUBLISHER Expert Reviews Ltd., 2 Albert Place, London, United Kingdom. ABSTRACT Recently, growing attention has been devoted to developing patient decision aids and decisional support interventions to aid patients in their decision-making when making treatment choices in oncology. Treatment discussions are challenging, both for physicians to transfer medical information to patients, and for patients to conceptualize these risks and benefits and to form a treatment decision. This article provides an overview of the recent literature on decision-making preferences, treatment preferences and decisional support development in radiation oncology. We review the findings from studies that were conducted in radiation oncology that investigated patients' preferences for radical or palliative radiotherapy across all cancer sites and discuss the challenges of transferring medical information to patients. © 2012 Expert Reviews Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer radiotherapy oncology patient decision making EMTREE MEDICAL INDEX TERMS bone metastasis brachytherapy brain metastasis breast cancer cancer localization cancer palliative therapy cancer survival external beam radiotherapy head and neck cancer human life expectancy non small cell lung cancer patient information patient participation patient preference patient satisfaction prostate cancer quality of life radiation dose fractionation review treatment indication treatment outcome EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012065955 MEDLINE PMID 22280199 (http://www.ncbi.nlm.nih.gov/pubmed/22280199) PUI L364172862 DOI 10.1586/erp.11.82 FULL TEXT LINK http://dx.doi.org/10.1586/erp.11.82 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 306 TITLE Radiation therapy for ductal carcinoma in situ: A decision analysis AUTHOR NAMES Punglia R.S. Burstein H.J. Weeks J.C. AUTHOR ADDRESSES (Punglia R.S., rpunglia@lroc.harvard.edu) Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, 44 Binney Street, Boston, MA 02115, United States. (Burstein H.J.; Weeks J.C.) Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS R.S. Punglia, Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, 44 Binney Street, Boston, MA 02115, United States. Email: rpunglia@lroc.harvard.edu SOURCE Cancer (2012) 118:3 (603-611). Date of Publication: 1 Feb 2012 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND: The benefit of adding radiation therapy after excision of ductal carcinoma in situ (DCIS) is widely debated. Randomized clinical trials are underpowered to delineate long-term outcomes after radiation. METHODS: The authors of this report constructed a Markov decision model to simulate the clinical course of DCIS in a woman aged 60 years who received treatment with either of 2 breast-conserving strategies: excision alone or excision plus radiation therapy. Sensitivity analyses were used to study the influence of risk of local recurrence, likelihood of invasive disease at recurrence, surgical choice at recurrence, and patient age at diagnosis on treatment outcomes. RESULTS: The addition of radiation therapy was associated with slight improvements in invasive disease-free and overall survival. However, radiation therapy decreased the chance of having both breasts intact over a patient's lifetime. Radiation therapy improved survival by 2.1 months for women who were diagnosed with DCIS at age 60 years but decreased the chance of having both breasts by 8.6% relative to excision alone. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed a greater benefit for radiation with an increased likelihood of invasive recurrence. The decrement in breast preservation with radiation therapy was mitigated by an increased likelihood of mastectomy at the time of recurrence or new breast cancer diagnosis. CONCLUSIONS: The current analysis quantified the benefits of radiation after excision of DCIS but also revealed that radiation therapy may increase the likelihood of eventual mastectomy. Therefore, the authors concluded that patient age and preferences should be considered when making the decision to add or forgo radiation for DCIS. © 2011 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer radiotherapy intraductal carcinoma EMTREE MEDICAL INDEX TERMS age article breast surgery cancer recurrence controlled study disease free survival mastectomy overall survival priority journal probability recurrence risk simulation surgical technique treatment outcome tumor invasion EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012052343 MEDLINE PMID 21720992 (http://www.ncbi.nlm.nih.gov/pubmed/21720992) PUI L51506864 DOI 10.1002/cncr.26293 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.26293 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 307 TITLE An evaluation of the quality of online resources for breast cancer patients AUTHOR NAMES Brar B. Lin J. Ingledew P. AUTHOR ADDRESSES (Brar B.; Lin J.) University of British Columbia, Vancouver, Canada. (Ingledew P.) B.C. Cancer Agency, Surrey, Canada. CORRESPONDENCE ADDRESS B. Brar, University of British Columbia, Vancouver, Canada. SOURCE Journal of Investigative Medicine (2012) 60:1 (232-233). Date of Publication: January 2012 CONFERENCE NAME American Federation for Medical Research Western Regional Meeting, AFMR 2012 CONFERENCE LOCATION Carmel, CA, United States CONFERENCE DATE 2012-01-25 to 2012-01-28 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: Cancer patients are increasingly using the internet to guide decision-making concerning their disease. Although there is a substantial amount of information available on the internet regarding breast cancer, there are no studies evaluating whether it is comprehensive enough to support patients' decision making. The purpose of this study was to analyze the quality of online breast cancer information. Methods Used: Using the meta-search engines Yippy and Dogpile, and the search engine Google, a list of 100 breast cancer websites was compiled. The websites were assessed for accountability, interactivity, organization, readability, and content using a previously validated structured rating tool. Interrater reliability was assessed. Summary of Results: The majority of the breast cancer websites were administered by commercial businesses (47%) and non-profit organizations (33%). 86% of the websites disclosed ownership, sponsorship, and/or advertising. Only 34% of websites identified the author and 39% cited sources. The majority of the information was out of date and 27% of websites had updated their content within the last two years. The average readability was a grade 9 level. Almost all websites were completely accurate or mostly accurate. While 88% of the websites sufficiently covered breast cancer, only 18% addressed prognosis. Conclusions: Although the assessed websites were mostly accurate there were significant deficits in authorship, attribution, and currency. Additionally, very few provided information regarding prognosis. These data can be used to counsel patients on the strengths and weaknesses of web-based breast cancer information and to empower patients to choose sites likely to enhance their personal knowledge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human medical research EMTREE MEDICAL INDEX TERMS advertising commercial phenomena decision making Internet interrater reliability non profit organization organization and management patient prognosis reading search engine weakness writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70983319 DOI 10.231/JIM.0b013e318240c940 FULL TEXT LINK http://dx.doi.org/10.231/JIM.0b013e318240c940 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 308 TITLE Breast conserving surgery or mastectomy - An urban bias? A rural surgical patient population and factors that lend to therapeutic decisions in breast cancer AUTHOR NAMES Wooldridge R.D. Borgstrom D.C. AUTHOR ADDRESSES (Wooldridge R.D.; Borgstrom D.C.) Bassett Medical Center, Cooperstown, United States. CORRESPONDENCE ADDRESS R.D. Wooldridge, Bassett Medical Center, Cooperstown, United States. SOURCE Cancer Research (2011) 71:24 SUPPL. 3. Date of Publication: 15 Dec 2011 CONFERENCE NAME 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2011-12-06 to 2011-12-10 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: For women with early stage breast cancer, it is accepted that BCS followed by radiation therapy yields equivalent results to mastectomy. Over the past 20 years, rates of women choosing BCS have increased. However, the national mastectomy rate remains high. Multiple influential factors have been investigated in efforts to define those that aid in surgical decision making, including age, race, education concerning surgical options, and the influence of their surgeon and discussion regarding surgical options. Our study centered on our rural breast cancer population, anticipating that a woman's surgical choice might be affected by unique rural factors not present in an urban setting. Methods: Stage 0-II breast cancer patients were identified using the Tumor Registry for 1/2000 through 12/2008. Patients were divided into two groups based on surgical procedure, BCS or mastectomy, and mailed a survey. Questions included basic demographics in addition to concerns of recurrence, driving distance to the nearest radiation center, potential need for another operation, influence by educational materials or family members, discussion of options with their surgeon, as well as if they sought a second opinion. Responses were assigned values using a Likert scale. Univariate analyses were performed to detect relationships between surgery choice and survey variables. Those variables found to be significant at the univariate level were entered into a multivariate logistic regression model predicting the probability of mastectomy versus BCS. Results: An overall response rate of 83.1% was achieved, with a total of 283 completed surveys. The mean age at the time of surgery was 61.1 years (SD 9.3), which was not statistically significant. The univariate analyses detected four statistically significant variables related to surgical choice - the worry about recurrence (91.6% mastectomy patients, 55.4% BCS patients: p-value <0.0001), a faster return to “normal life” (51.7% mastectomy patients, 69.9% of BSC patients: p-value 0.039), avoiding another operation (68.9% mastectomy patients, 45.2% BCS patients: p-value 0.012), and having obtained a second opinion (30.5% of mastectomy patients, 16.7% BCS patients: p-value 0.036). There was no difference in surgical choice when comparing for age, level of education, distance from a radiation center, or concerns about driving in inclement weather. The resulting multivariate logistic regression model showed the strongest independent predictor of surgical choice to be worry about breast cancer recurrence, with a p-value of 0.0005 and an odds ratio of 6.1 (95% CI 2.2-16.7). The desire for a faster return to a normal life was also significantly predictive in this model. Regarding the patient's impression of the discussion with their surgeon about their surgical options, 95.2% of mastectomy patients and 89.2% BCS patients stated that their surgeon discussed both as surgical choices. Conclusions: Anticipated rural-unique factors were not related to surgical decision making in our population of early stage breast cancer patients. Concern about breast cancer recurrence was the most strongly associated factor in the choice of mastectomy over BCS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer human mastectomy partial mastectomy population surgical patient EMTREE MEDICAL INDEX TERMS cancer patient decision making education female Likert scale logistic regression analysis model neoplasm patient radiation radiotherapy register risk statistical significance surgeon surgery surgical technique univariate analysis weather LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71077811 DOI 10.1158/0008-5472.SABCS11-P1-11-03 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS11-P1-11-03 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 309 TITLE Development of a patient decision aid for women 70 years and older with stage I, hormonally sensitive, breast cancer considering adjuvant treatment post-lumpectomy AUTHOR NAMES Szumacher E. Wong J. D'Alimonte L. Angus J. Paszat L. Metcalfe K. Whelan T. Llewellyn-Thomas H. AUTHOR ADDRESSES (Szumacher E.; Wong J.; D'Alimonte L.; Angus J.; Paszat L.; Metcalfe K.; Whelan T.; Llewellyn-Thomas H.) Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. (Szumacher E.; Wong J.; D'Alimonte L.; Angus J.; Paszat L.; Metcalfe K.; Whelan T.; Llewellyn-Thomas H.) University of Toronto, Toronto, ON, Canada; Education Independent Consultant, Toronto, ON; Juravinski Cancer Centre, Hamilton, ON, Canada; Women's College Research Institute, Toronto, ON, Canada; Dartmouth Medical School, Lebanon, NH CORRESPONDENCE ADDRESS E. Szumacher, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. SOURCE Cancer Research (2011) 71:24 SUPPL. 3. Date of Publication: 15 Dec 2011 CONFERENCE NAME 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2011-12-06 to 2011-12-10 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Decision Aids (DA) are developed with the intent to support people in making specific and deliberate choices by improving information transfer about different outcomes. Previous research has shown that DAs can increase patient knowledge regarding treatment options, reduce decisional conflict, and increase patient satisfaction with the decision-making process. However, no DAs have been developed to help older breast cancer patients decide whether or not to undergo adjuvant RT. We developed and tested a DA for older women with stage I,ER/PR positive breast cancer considering adjuvant treatment post-lumpectomy and we examined its impact on treatment decision-making process. Methods and Materials: A DA was developed and evaluated in three steps following the Ottawa Decision Aid Framework: 1) Needs assessment (N=16); 2) Pilot I, to examine the DA's acceptability (N=12); and 3) Pilot II, a pre-test post-test (N=38) with older women with ER/PR responsive breast cancer post-lumpectomy who were receiving adjuvant RT. Measures included questionnaires to assess patient's satisfaction with the DA, patients' self-reported decisional conflict (DC), level of distress, treatment-related knowledge, and choice predisposition Results: The DA is a booklet that details each adjuvant treatment option's benefits, risks and side-effects tailored to their clinical profile; includes a value clarification exercise; and steps to guide them towards their own treatment decision. All women felt the DA was helpful and informative. Compared with baseline scores, patients had a statistically significant (p < .05) reduction in DC (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the treatment benefits and risks (AMD, -10.86, CI, -20.33 to 21.49; and improved general treatment knowledge (AMD, 8.99, CI, 2.88 to 10.28) after using the DA. General trends were also reported in patient's choice predisposition scores suggesting potential differences in treatment decision after DA use. EMTREE DRUG INDEX TERMS adjuvant methyldopa EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast cancer female human partial mastectomy patient EMTREE MEDICAL INDEX TERMS cancer patient confidence interval decision making disease predisposition exercise hospital patient needs assessment patient satisfaction potential difference questionnaire risk side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71078602 DOI 10.1158/0008-5472.SABCS11-P5-15-03 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS11-P5-15-03 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 310 TITLE A decision analysis of contralateral prophylactic mastectomy in women undergoing treatment for sporadic unilateral breast cancer AUTHOR NAMES Lester-Coll N.H. Lee J.M. Gogineni K. Hwang W.-T. Schwartz J.S. Prosnitz R.G. AUTHOR ADDRESSES (Lester-Coll N.H.; Lee J.M.; Gogineni K.; Hwang W.-T.; Schwartz J.S.; Prosnitz R.G.) University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States. (Lester-Coll N.H.; Lee J.M.; Gogineni K.; Hwang W.-T.; Schwartz J.S.; Prosnitz R.G.) Massachusetts General Hospital, Boston, MA; Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA CORRESPONDENCE ADDRESS N.H. Lester-Coll, University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States. SOURCE Cancer Research (2011) 71:24 SUPPL. 3. Date of Publication: 15 Dec 2011 CONFERENCE NAME 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2011-12-06 to 2011-12-10 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: The intent of contralateral prophylactic mastectomy (CPM) is to improve survival after a diagnosis of unilateral breast cancer by reducing the risk of contralateral breast cancer (CBC). CPM rates are rising among women with sporadic breast cancer, despite limited evidence that its benefits outweigh its harms. Although CPM is highly effective in reducing a woman's risk of CBC, the competing mortality risk from a patient's index breast cancer may offset its benefits. Furthermore, any examination of CPM needs to consider quality of life effects. Methods: We developed a Markov decision analytic model to estimate the effect of CPM in women with newly diagnosed unilateral breast cancer. The primary outcomes examined were gains in life expectancy (LE) and quality-adjusted life expectancy (QALE) for CPM compared with no CPM in 18 hypothetical cohorts of 45-year old women. Data from the British Columbia Cancer Agency (BCCA) was used to generate AJCC stage and molecular subtype-specific estimates of the risk of developing distant metastases from an index breast cancer. A correction factor was applied to account for the omission of relevant systemic therapy (including trastuzamab) in some women in the BCCA cohort. Additional model parameters, including utilities (quality of life weights) for breast cancer and CPM health states, were identified from the published medical literature. LE and QALE estimates were not discounted in the base case. Univariate sensitivity analysis was used to examine the impact of plausible variation in the key model parameters on model results. Results: CPM improved LE in all cohorts (range: 0.06 - 0.54 years, Table 1). AJCC stage had more effect on LE than molecular subtype (stage I mean, 0.43 years, stage III mean, 0.11 years). However, after adjusting for quality of life, a strategy of no CPM was favored in all cohorts. Univariate sensitivity analysis demonstrated that the only model parameter that influenced the outcome of QALE was the utility for health after CPM. In the base case the utility after CPM was 0.81 (compared to 0.85 for No CPM). The preferred strategy did not change from No CPM to CPM unless the utility after CPM exceeded 0.83. Model results were otherwise stable across the ranges of the key parameters examined, including the risk of distant metastases resulting from a patient's index breast cancer by stage and subtype, duration of survival with metastatic breast cancer, and the risk of CBC. Conclusions: The primary drivers of survival after unilateral breast cancer are stage at diagnosis and molecular subtype. Our model demonstrates that CPM confers modest additional LE gains, even in women with early-stage, favorable-subtype breast cancer. Furthermore, this modest benefit is negated if one assumes a small reduction in quality of life due to CPM. The decision to pursue CPM as part of treatment of unilateral breast cancer should include consideration of both patient specific breast cancer characteristics and individual preferences. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female human mastectomy EMTREE MEDICAL INDEX TERMS Canada diagnosis distant metastasis examination health health status life expectancy medical literature metastatic breast cancer model mortality neoplasm parameters patient quality of life risk sensitivity analysis survival systemic therapy weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71077649 DOI 10.1158/0008-5472.SABCS11-PD02-02 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS11-PD02-02 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 311 TITLE Standardized pretreatment breast MRI-accuracy and influence on mastectomy decisions AUTHOR NAMES Barchie M.F. Clive K.S. Tyler J.A. Sutcliffe J.B. Kirkpatrick A.D. Bell L.M. Banks K.P. Belenkiy S. Saenger J.S. Peoples G.E. AUTHOR ADDRESSES (Barchie M.F., mbarchie@satx.rr.com; Sutcliffe J.B.; Kirkpatrick A.D.; Bell L.M.; Banks K.P.) Department of Radiology, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200, United States. (Clive K.S.; Tyler J.A.; Belenkiy S.; Peoples G.E.) Department of Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX, United States. (Saenger J.S.) Department of Pathology, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX, United States. CORRESPONDENCE ADDRESS M.F. Barchie, Department of Radiology, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200, United States. Email: mbarchie@satx.rr.com SOURCE Journal of Surgical Oncology (2011) 104:7 (741-745). Date of Publication: December 2011 ISSN 0022-4790 1096-9098 (electronic) BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT Background and Objectives Routine pretreatment breast magnetic resonance imaging in newly diagnosed cancer patients remains controversial. We assess MRI accuracy and influence on mastectomy decisions after institution of standardized pretreatment MRI. Methods A prospectively collected database of 74 consecutive new invasive breast cancer patients with pretreatment breast MRI was reviewed for treatment choice, radiologic, and pathologic results. Thirty-eight of 72 patients with available surgical records underwent mastectomy. Mastectomy preoperative and operative electronic records were reviewed for treatment decision analysis. Results Seventeen of 72 (23.6%) invasive breast cancer patients were likely influenced to undergo mastectomy by new information from MRI. MRI reported that the multifocal/multicentric (MF/MC) rate was 20 of 72 (27.8%) versus 19 of 72 (26.4%) by surgical pathology. MRI sensitivity for MF/MC disease was 89.5% versus 11.8% for mammography. MRI specificity was 84.2%. All three false positives declined recommended preoperative biopsies. MRI MF/MC diagnosis highly correlated with pathology results, P < 0.001. Conclusions Increased mastectomy rate from 29 to 52.8% after standardization of pre-treatment breast MRI for invasive cancer is largely due to MRI findings of increased extent of disease. These MRI findings correlate well with pathologic findings and appear to justify the performance of mastectomies in these patients. J. Surg. Oncol. 2011; 104:741-745. © 2011 Wiley Periodicals, Inc. Copyright © 2011 Wiley Periodicals, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, surgery) mastectomy nuclear magnetic resonance imaging EMTREE MEDICAL INDEX TERMS adult article breast biopsy breast carcinoma (diagnosis, surgery) breast carcinoma (diagnosis, surgery) cancer diagnosis cancer staging controlled study data base diagnostic accuracy diagnostic test accuracy study electronic medical record female human human tissue intraductal carcinoma (diagnosis, surgery) major clinical study mammography medical decision making medical record preoperative care priority journal prospective study tumor invasion EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011605026 MEDLINE PMID 21618242 (http://www.ncbi.nlm.nih.gov/pubmed/21618242) PUI L51446820 DOI 10.1002/jso.21960 FULL TEXT LINK http://dx.doi.org/10.1002/jso.21960 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 312 TITLE Decision aids for surgical treatment of early stage breast cancer: A narrative review of the literature AUTHOR NAMES Obeidat R. Finnell D.S. Lally R.M. AUTHOR ADDRESSES (Obeidat R., robeidat@buffalo.edu; Finnell D.S.; Lally R.M.) School of Nursing, University at Buffalo, The State University of New York, Buffalo, United States. CORRESPONDENCE ADDRESS R. Obeidat, University at Buffalo, The State University of New York, 201 Wende Hall, 3435 Main Street, Buffalo, NY 14214-3079, United States. Email: robeidat@buffalo.edu SOURCE Patient Education and Counseling (2011) 85:3 (e311-e321). Date of Publication: December 2011 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To review and critique the published empirical research on decision aids for women actually facing surgical treatment of early stage breast cancer, synthesize findings across studies related to outcomes of decision aids use with specific attention to the influence of system and client characteristics, and identify opportunities for further research. Methods: A systematic and reproducible search was carried out to identify studies evaluating decision aids for women making breast cancer surgical treatment decisions. All included studies were appraised. Results: Most studies evaluated the outcomes of decision aids use in terms of final treatment decisions, patients' knowledge of treatment options, anxiety, decisional conflict, satisfaction and quality of life. Included studies varied in design, measures used to assess effectiveness, format of the aids, patient populations and clinical settings. Studies yielded mixed results related to the effect of the decision aids on the outcomes measured. Conclusion: Despite the mixed findings of the studies, some support exists for the use of decision aids with women diagnosed with early stage breast cancer. Practice implications: To ensure successful implementation of decision aids in clinical practice, healthcare providers should be educated on their use. Greater allocation of time, space and access to decision aids is also needed. © 2011 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer surgery decision support system EMTREE MEDICAL INDEX TERMS cancer patient cancer staging clinical decision making clinical effectiveness clinical practice doctor patient relation early cancer (surgery) human medical education medical information patient information patient preference patient satisfaction priority journal quality of life reproducibility review EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011639475 MEDLINE PMID 21543184 (http://www.ncbi.nlm.nih.gov/pubmed/21543184) PUI L51402168 DOI 10.1016/j.pec.2011.03.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2011.03.019 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 313 TITLE Study protocol: addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: a knowledge translation implementation study. AUTHOR NAMES Hack T.F. Ruether J.D. Weir L.M. Grenier D. Degner L.F. AUTHOR ADDRESSES (Hack T.F.) Faculty of Nursing, University of Manitoba, Winnipeg, Canada. (Ruether J.D.; Weir L.M.; Grenier D.; Degner L.F.) CORRESPONDENCE ADDRESS T.F. Hack, Faculty of Nursing, University of Manitoba, Winnipeg, Canada. Email: thack@sbrc.ca SOURCE Implementation science : IS (2011) 6 (20). Date of Publication: 2011 ISSN 1748-5908 (electronic) ABSTRACT The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. Consultation recording has been used in oncology, family medicine, and other medicine specialties, and despite affirming evidence and probable applications to a large number of diseases and a variety of clinical contexts, clinical adoption of this intervention has been slow. The proposed study findings will advance our conceptual knowledge of the ways to enhance uptake of consultation recordings in oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor doctor patient relation oncology patient referral prostate tumor recording EMTREE MEDICAL INDEX TERMS article Canada devices evidence based medicine female human information processing interpersonal communication intervention study interview male multicenter study patient education psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 21401958 (http://www.ncbi.nlm.nih.gov/pubmed/21401958) PUI L560079126 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 314 TITLE The assessment of fertility-related knowledge and decision-making preferences around diagnosis and the prospective evaluation of a fertility-related decision aid in young women with early breast cancer AUTHOR NAMES Peate M. Meiser B. Hickey M. Saunders C. Butow P. Zorbas H. Cheah B.C. Hadzi-Pavlovic D. Friedlander M. AUTHOR ADDRESSES (Peate M.; Meiser B.; Friedlander M.) Prince of Wales Clinical School, University of NSW, Randwick, Australia. (Peate M.; Meiser B.; Friedlander M.) Medical Oncology, Prince of Wales Hospital, Randwick, Australia. (Hickey M.) Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia. (Saunders C.) School of Surgery, University of WA, Crawley, Australia. (Butow P.) Centre of Medical Psychology and Evidence Based Decision-Making, University of Sydney, Australia. (Zorbas H.) National Breast and Ovarian Cancer Centre, Surry Hills, Australia. (Cheah B.C.) Neuroscience Research Australia, University of NSW, Randwick, Australia. (Hadzi-Pavlovic D.) Black Dog Institute, Randwick, Australia. CORRESPONDENCE ADDRESS M. Peate, Prince of Wales Clinical School, University of NSW, Randwick, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2011) 7 SUPPL. 4 (157-158). Date of Publication: November 2011 CONFERENCE NAME 38th Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA 2011 CONFERENCE LOCATION Perth, WA, Australia CONFERENCE DATE 2011-11-15 to 2011-11-17 ISSN 1743-7555 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Fertility is a priority for many young women with early-stage breast cancer (EBC). Interventions to retain fertility generally need to be accessed before chemotherapy, but women need to know about their options to make informed decisions. Aims: To assess fertility knowledge and decisional conflict (DC) in young women with newly-diagnosed EBC. To prospectively evaluate, compared to usual care, the efficacy of a fertility-related decision aid (DA). Methods: 120 recently diagnosed patients aged 18-40 years with EBC, who desired future fertility, were recruited from 19 Australian oncology clinics. Baseline knowledge regarding fertility-related information, DC, and information/ decision-making preferences were measured. Participants were allocated to receive either the DA or usual care. The fertility-related DC, decision regret, and patient satisfaction were measured at one and twelve months. Intention-to-treat linear mixed effects modelling examined the effect of the intervention. Results: Decreased knowledge was associated with increased DC (OR = 0.57; 95%CI:[0.44, 0.73]; p < 0.001). Consideration of IVF was not related to relationship status (OR = 1.20; 95%CI:0.45-3.20; p = 0.72) or desire for children (OR = 1.54; 95%CI:[0.42, 5.60]; p = 0.51). Compared to usual care, women who received the DA had significantly reduced DC, adjusted for education, desire for children and uncertainty at baseline (β = -1.51, 95%CI:[-2.54, -0.48], p = 0.004); reduced decisional regret, adjusted for education (β = -3.73, 95%CI:[-7.12, -0.35], p = 0.03); greater satisfaction with the information received on the impact of breast cancer treatment on fertility (χ(2) = 15.49, p < 0.001) and on their fertility options (χ(2) = 10.66, p = 0.005); and rated fertility information received as more helpful (χ(2) = 0.61, p = 0.002). Conclusions: Around diagnosis, many young EBC patients have low fertility- related knowledge. Low knowledge is associated with increased DC, which is likely to undermine the quality of decision-making. Neither relationship status nor firm plans regarding future children reliably predict desire to pursue fertility preservation. Compared to usual care, the DA reduced DC, decision regret and increased satisfaction. These findings support the widespread use of this DA shortly after diagnosis for younger EBC patients who have not completed their families. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia breast cancer decision making diagnosis female fertility human society EMTREE MEDICAL INDEX TERMS cancer therapy chemotherapy child education hospital intention to treat analysis model oncology patient patient satisfaction preservation satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70586903 DOI 10.1111/j.1743-7563.2011.01472.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1743-7563.2011.01472.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 315 TITLE The australian experience - Consumer involvement across the continuum of cancer control AUTHOR NAMES Zorbas H. AUTHOR ADDRESSES (Zorbas H.) Cancer Australia, Surry Hills, Australia. CORRESPONDENCE ADDRESS H. Zorbas, Cancer Australia, Surry Hills, Australia. SOURCE Asia-Pacific Journal of Clinical Oncology (2011) 7 SUPPL. 4 (85). Date of Publication: November 2011 CONFERENCE NAME 38th Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA 2011 CONFERENCE LOCATION Perth, WA, Australia CONFERENCE DATE 2011-11-15 to 2011-11-17 ISSN 1743-7555 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Consumers are key stakeholders in cancer control. Better outcomes are achieved when cancer control efforts are informed by the consumer experience, with facilitation of patient-centred approaches across the continuum of cancer control. Health service delivery, best practice clinical and supportive care and research are just some aspects of cancer control which can benefit by incorporating lessons from the patient experience. People affected by cancer are increasingly seeking active participation in decision making about their health. There is a need for access to appropriate and evidence-based information for consumers that supports informed decision making about cancer risk, prevention and early detection as well as active involvement of people affected by cancer in decisions about all aspects of their care. Strategic and inclusive approaches to consumer engagement are required. Cancer Australia in partnership with Cancer Voices Australia, has developed a National Framework for Consumer Involvement in Cancer Control (Framework) to enhance meaningful consumer involvement at all levels of cancer control, in order to improve outcomes and experiences for people affected by cancer. The framework provides a system wide approach to consumer engagement and identifies four key elements as essential for effective consumer involvement: organisations committed to meaningful consumer engagement; capable consumers supported to engage meaningfully; inclusive groups where consumers are engaged as an integral team member; and shared focus where all group members share a common goal. Multidisciplinary care is a pivotal setting for meaningful input into the patient experience. Multidisciplinary care is an integrated team-based approach to cancer care that can improve survival as well as quality of life for the patient. Principles of Multidisciplinary Care were developed by National Breast Cancer Centre to provide a framework for a flexible approach to implement multidisciplinary care across the Australian health care system. Effective elements and features in the Framework complement the key success factors for effective multidisciplinary care, including champions to promote the benefits and evidence for involving consumers in decision making; mutual respect where consumers' contributions are valued; and effective communication between team members and consumers. Applying the key elements of the Framework and the Principles will lead to more integrated consumer involvement in cancer control, improved cancer patient experience and ultimately better outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia cancer control consumer society EMTREE MEDICAL INDEX TERMS breast cancer cancer center cancer patient cancer risk decision making evidence based practice health health care delivery health care system health service human interpersonal communication neoplasm patient prevention quality of life survival voice LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70587068 DOI 10.1111/j.1743-7563.2011.01477.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1743-7563.2011.01477.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 316 TITLE The prognostic importance of cathepsin D and E-cadherin in early breast cancer: A single-institution experience AUTHOR NAMES Jacobson-Raber G. Lazarev I. Novack V. Mermershtein W. Baumfeld Y. Geffen D.B. Sion-Vardy N. Ariad S. AUTHOR ADDRESSES (Jacobson-Raber G.; Lazarev I.; Mermershtein W.; Geffen D.B.; Ariad S., ariads@clalit.org.il) Departments of Oncology, Soroka Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel. (Novack V.; Baumfeld Y.) Clinical Research Center, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva 84101, Israel. (Sion-Vardy N.) Departments of Pathology, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva 84101, Israel. CORRESPONDENCE ADDRESS S. Ariad, Departments of Oncology, Soroka Medical Center, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel. Email: ariads@clalit.org.il SOURCE Oncology Letters (2011) 2:6 (1183-1190). Date of Publication: November 2011 ISSN 1792-1074 1792-1082 (electronic) BOOK PUBLISHER Spandidos Publications Ltd., 10 Vriaxidos Street, Athens, Greece. ABSTRACT Molecular tools have increasingly been used for decision-making in patients with early breast cancer (EBC). Nevertheless, simple tools such as immunohistochemistry may still be required in particular cases to complement traditional and molecular prognosticators. In this study, the prognostic significance of three well-known immunohistochemical biomarkers, cathepsin D, E-cadherin and Ki67, was studied in 270 patients with EBC, followed by a median time of 126 months in a single institution. Histological examination was performed to confirm the histopathological diagnosis and select specimens. The specimens were evaluated using immunohistochemistry and survival curves were plotted. Results revealed the following patient characteristics: node-negative/1-3 lymph nodes in 228 (86%) patients, hormone receptor-positive in 217 (80%); triple-negative in 31 (11%), and Her2-overexpression in 23 (9%) patients. Breast cancer-related events occurred in 37 patients (14%). A total of 217 patients (80%) survived. Receiver operating characteristic analysis for breast cancer-specific survival showed an area under curve for the clinicopathological model of 0.75 (95% CI, 0.64-0.86), 0.79 (95% CI, 0.68-0.90) for the three-biomarker model, and 0.82 (95% CI, 0.72-0.92) for the E-cadherin and cathepsin D only model. We propose that a simple prognostic model based on combined scores of E-cadherin and cathepsin D may aid treatment decisions in patients with EBC. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cathepsin D (endogenous compound) Ki 67 antigen (endogenous compound) uvomorulin (endogenous compound) EMTREE DRUG INDEX TERMS epidermal growth factor receptor 2 (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) EMTREE MEDICAL INDEX TERMS adult aged article cancer diagnosis cancer survival early cancer histopathology human human tissue immunohistochemistry prognosis CAS REGISTRY NUMBERS cathepsin D (9025-26-7) epidermal growth factor receptor 2 (137632-09-8) uvomorulin (112956-45-3) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011514856 PUI L362551089 DOI 10.3892/ol.2011.393 FULL TEXT LINK http://dx.doi.org/10.3892/ol.2011.393 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 317 TITLE Health technology assessment-based development of a Spanish breast cancer patient decision aid AUTHOR NAMES Izquierdo F. Gracia J. Guerra M. Blasco J.A. Andradas E. AUTHOR ADDRESSES (Izquierdo F., fatima.izquierdo@uets.info; Gracia J., javier.gracia@salud.madrid.org; Guerra M., mercedes.guerra@uets.info; Blasco J.A., juan.blascoa@salud.madrid.org; Andradas E., elena.andradas@salud.madrid.org) Agencia Lain Entralgo, Unidad de Evaluación de Tecnologías Sanitarias, C/Gran Via 27, Madrid 28013, Spain. CORRESPONDENCE ADDRESS F. Izquierdo, Agencia Lain Entralgo, Unidad de Evaluación de Tecnologías Sanitarias, C/Gran Via 27, Madrid 28013, Spain. Email: fatima.izquierdo@uets.info SOURCE International Journal of Technology Assessment in Health Care (2011) 27:4 (363-368). Date of Publication: October 2011 ISSN 0266-4623 1471-6348 (electronic) BOOK PUBLISHER Cambridge University Press, 40 West 20th Street, New York, United States. ABSTRACT Objectives: The aim of this study was to develop a breast cancer Patient Decision Aid (PDA), using a Health Technology Assessment (HTA) process, to assist patients in their choice of therapeutic options, and to promote shared decision making among patients, healthcare professionals, and other interested parties. Methods: A systematic review (SR) was conducted of existing breast cancer patient Decision Aids encountered in the main scientific journal databases and on institutional Web sites that create PDAs, together with a Qualitative Research (QR) study, using semi-structured interviews and focus group with stakeholders (patients, family members, and health professionals), with the aim of developing a PDA for breast cancer. Results: The SR shows that PDAs in breast cancer not only increase patient knowledge of the illness, leading to more realistic expectations of treatment outcomes, but also reduce passivity in the decision-making process and facilitate the appropriate choice of treatment options in accordance with patient medical and personal preferences. The analysis of QR shows that both breast cancer patients and healthcare professionals agree that surgery, adjuvant treatments, and breast reconstruction represent the most important decisions to be made. Worry, anxiety, optimism, and trust in healthcare professionals were determined as factors that most affected patients subjective experiences of the illness. This HTA was used as the basis for developing a PDA software program. Conclusions: The SR and QR used in the development of this PDA for breast cancer allowed patients to access information, gain additional knowledge of their illness, make shared treatment decisions, and gave healthcare professionals a deeper insight into patient experiences of the disease. © Cambridge University Press 2011. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biomedical technology assessment clinical assessment tool decision making health care personnel patient decision aid EMTREE MEDICAL INDEX TERMS anxiety article breast cancer breast reconstruction cancer adjuvant therapy cancer surgery doctor patient relation human knowledge optimism patient preference qualitative research semi structured interview systematic review treatment outcome trust EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012176819 MEDLINE PMID 22004778 (http://www.ncbi.nlm.nih.gov/pubmed/22004778) PUI L364506927 DOI 10.1017/S0266462311000493 FULL TEXT LINK http://dx.doi.org/10.1017/S0266462311000493 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 318 TITLE Treatment choices and factors determining choices in early stage breast cancer patients AUTHOR NAMES Caliskan Z. Elbi H. AUTHOR ADDRESSES (Caliskan Z.; Elbi H.) Ege University, Izmir, Turkey. CORRESPONDENCE ADDRESS Z. Caliskan, Ege University, Izmir, Turkey. SOURCE Psycho-Oncology (2011) 20 SUPPL. 2 (99-100). Date of Publication: October 2011 CONFERENCE NAME 13th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Antalya, Turkey CONFERENCE DATE 2011-10-16 to 2011-10-20 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: The aim of the study was to examine the level of participation of early stage breast cancer patients in their treatment decision making, to determine how the features of patients affect their roles in treatment decisions and to assess their needs of information concerning their treatment. This study also sought to evaluate the relationship between the psychological aspects, perceptions of social support and decision making processes of breast cancer women at time of surgical treatment. METHOD: The patients with a diagnosis of breast cancer were recruited from the Surgery Department of Ege University. A total of 79 patients were eligible for the study. Due to several factors like reluctance, or being unfit for completing the scales, or advanced stage, the sample consisted of 48 early stage (stage I-II) breast cancer patients. The women were interviewed prior to their operation. Also Multidimensional Scale of Perceived Support, Hospital Anxiety and Depression Scale and Decisional Conflict Scale were utilized in this study. The study was approved by the Medical Ethical Committee of Ege University Medical School. RESULTS: Before their operation, %56 of the women were not informed if they would have mastectomy or lumpectomy. Patients who were informed about the surgical options were offered surgical choices whereas uninformed patients were not offered any choice. The patients that were offered choices, preferred to share their decision with the doctor and family. The patients that were not offered any choice preferred their surgeons to make the decision for the treatment. The informed patients reported less decisional conflict than uninformed patients. Also the patients with higher social support had lower decisional conflict than the patients with lower social support. CONCLUSIONS: More than half of the patients reported that they were not offered any surgical choice. The lack of dialogue about the surgical preferences may be rooted in classical paternalistic approach. The level of informed patients about the disease and surgical options was inadequate. The majority of patients prefer to share the responsibility of decision making with their surgeon. RESEARCH IMPLICATIONS: Informing the patients about the disease and alternative surgical options and asking their participation in treatment choice is important for mental adaptation to breast cancer. The treatment choices and factors determining the choices of patients in early stage breast cancer needs further study. CLINICAL IMPLICATIONS: The patients that are informed about the surgical options has less decisional conflict than the patients that are not informed. So, informing the patients about their illness and treatment options should be taken into consideration. Also while informing the patients, their education level should be regarded. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient human oncology society EMTREE MEDICAL INDEX TERMS adaptation decision making diagnosis education female general aspects of disease Hospital Anxiety and Depression Scale mastectomy medical school partial mastectomy patient physician psychological aspect responsibility social support surgeon surgery university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70552964 DOI 10.1002/pon.2077 FULL TEXT LINK http://dx.doi.org/10.1002/pon.2077 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 319 TITLE Targeted and timely fertility information for young women with early breast cancer - Making choices now for the future AUTHOR NAMES Peate M. Meiser B. Hickey M. Saunders C. Butow P. Cheah B.C. Hadzi-Pavlovic D. Friedlander M. AUTHOR ADDRESSES (Peate M.; Meiser B.; Friedlander M.) University of NSW, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia. (Peate M.) Psycho-Oncology Cooperative Group (PoCoG), University of Sydney, Camperdown, Australia. (Hickey M.) Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia. (Saunders C.) Department of Surgery, University of Western Australia, Perth, Australia. (Butow P.) University of Sydney, Sydney, Australia. (Cheah B.C.) Neuroscience Research Australia, University of NSW, Randwick, Australia. (Hadzi-Pavlovic D.) Black Dog Institute, Randwick, Australia. CORRESPONDENCE ADDRESS M. Peate, University of NSW, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia. SOURCE Psycho-Oncology (2011) 20 SUPPL. 2 (60-61). Date of Publication: October 2011 CONFERENCE NAME 13th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Antalya, Turkey CONFERENCE DATE 2011-10-16 to 2011-10-20 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: Fertility is a priority for many young women with breast cancer. Interventions to retain fertility options generally need to be accessed before chemotherapy, but women need to know about their options to make informed decisions. Stage 1: To assess knowledge about fertility and decisional conflict in young women with newlydiagnosed, early-stage breast cancer considering future pregnancies. Stage 2: To prospectively evaluate the efficacy, compared to usual care, of a fertility-related decision aid (DA). METHOD: 120 patients with early-stage breast cancer, aged 18-40 years, who desired future fertility, were recruited from 19 Australian oncology clinics. Stage 1: Baseline knowledge regarding fertilityrelated information, decisional conflict, and preferences regarding fertility information and decision making were measured. Stage 2: Participants were allocated using a block design to receive either a fertility-related DA or usual care within a week of diagnosis. The fertility-related decisional conflict, decision regret, and patient satisfaction were measured at baseline and at 1 and 12 months follow-up. An intention-to-treat, linear mixed effects modelling was used to examine the effect of the DA on outcome variables. RESULTS: Stage 1: Decreased knowledge was associated with increased decisional conflict (OR=0.57; 95%CI:0.44-0.73; p<0.001). Consideration of IVF was not related to relationship status (OR=1.20; p=0.716) or desire for children (OR=1.54; p=0.513). Stage 2: Compared to usual care, women who received the DA had significantly: (a) reduced decisional conflict, adjusted for education, desire for children and uncertainty at baseline (p=0.004); (b) reduced decisional regret, adjusted for education (p=0.034); (c) greater satisfaction with the information received on the impact of breast cancer treatment on fertility (p<0.001) and on their fertility options (p=0.005); and (d) rated their fertility information as more helpful (p=0.002). CONCLUSIONS: Around diagnosis, many young patients with breast cancer have low levels of knowledge about fertility issues. Further, low knowledge is associated with increased decisional conflict, which is likely to undermine the quality of decision making. Neither relationship status nor firm plans regarding future children reliably predict desire to pursue fertility preservation at this time. Compared to usual care, the fertility DA reduced decisional conflict, decision regret and increased satisfaction. These findings support the widespread use of this DA shortly after diagnosis and prior to chemotherapy, for all younger breast cancer patients who have not completed their families. RESEARCH IMPLICATIONS: This is the first study to prospectively measure fertility-related knowledge and intentions, information preferences about fertility in this population, and the impact of a fertility decision aid on decisional conflict, decision regret and fertility choices in young breast cancer patients. It raises questions about the decision-making mechanisms about fertilityrelated issues in younger women with breast cancer which is propagate further research and provides further evidence about the efficacy of decision aids as decision support tools. CLINICAL IMPLICATIONS: This research has clear implications for the level and nature of fertility information required by young patients with breast cancer at diagnosis, in particular, the potential that improvements in patient knowledge may reduce uncertainty about fertility treatment decisions. Fertility-related information should be provided, irrespective of existing children or relationship status. Furthermore, confirmation that the fertility- related developed is an effective means to deliver this information that improves decisionmaking outcomes and should be integrated into clinical practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female fertility human oncology society EMTREE MEDICAL INDEX TERMS cancer patient cancer therapy chemotherapy child clinical practice decision making decision support system diagnosis education follow up hospital hospital patient intention to treat analysis model outcome variable patient patient satisfaction population pregnancy preservation satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70552908 DOI 10.1002/pon.2077 FULL TEXT LINK http://dx.doi.org/10.1002/pon.2077 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 320 TITLE Palliative medicine and decision science: The critical need for a shared agenda to foster informed patient choice in serious illness AUTHOR NAMES Bakitas M. Kryworuchko J. Matlock D.D. Volandes A.E. AUTHOR ADDRESSES (Bakitas M., marie.bakitas@hitchcock.org) Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH 03756, United States. (Kryworuchko J.) University of Saskatchewan, Saskatoon, SK, Canada. (Matlock D.D.) University of Colorado Denver, Aurora, CO, United States. (Volandes A.E.) Massachusetts General Hospital, Boston, MA, United States. CORRESPONDENCE ADDRESS M. Bakitas, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH 03756, United States. Email: marie.bakitas@hitchcock.org SOURCE Journal of Palliative Medicine (2011) 14:10 (1109-1116). Date of Publication: 1 Oct 2011 ISSN 1096-6218 1557-7740 (electronic) BOOK PUBLISHER Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States. ABSTRACT Assisting patients and their families in complex decision making is a foundational skill in palliative care; however, palliative care clinicians and scientists have just begun to establish an evidence base for best practice in assisting patients and families in complex decision making. Decision scientists aim to understand and clarify the concepts and techniques of shared decision making (SDM), decision support, and informed patient choice in order to ensure that patient and family perspectives shape their health care experience. Patients with serious illness and their families are faced with myriad complex decisions over the course of illness and as death approaches. If patients lose capacity, then surrogate decision makers are cast into the decision-making role. The fields of palliative care and decision science have grown in parallel. There is much to be gained in advancing the practices of complex decision making in serious illness through increased collaboration. The purpose of this article is to use a case study to highlight the broad range of difficult decisions, issues, and opportunities imposed by a life-limiting illness in order to illustrate how collaboration and a joint research agenda between palliative care and decision science researchers, theorists, and clinicians might guide best practices for patients and their families. © 2011, Mary Ann Liebert, Inc. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making palliative therapy EMTREE MEDICAL INDEX TERMS article breast cancer (drug therapy, radiotherapy) cancer hormone therapy cancer recurrence disease course disease severity health care personnel health care quality human intensive care unit mortality patient care patient decision making patient preference quality of life terminal care treatment planning treatment response EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011578493 MEDLINE PMID 21895453 (http://www.ncbi.nlm.nih.gov/pubmed/21895453) PUI L362766086 DOI 10.1089/jpm.2011.0032 FULL TEXT LINK http://dx.doi.org/10.1089/jpm.2011.0032 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 321 TITLE Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins AUTHOR NAMES Osborn J.B. Keeney G.L. Jakub J.W. Degnim A.C. Boughey J.C. AUTHOR ADDRESSES (Osborn J.B.; Jakub J.W.; Degnim A.C.; Boughey J.C., boughey.judy@mayo.edu) Department of Surgery, Mayo Clinic, Rochester, MN, United States. (Keeney G.L.) Department of Laboratory Medicine/Pathology, Mayo Clinic, Rochester, MN, United States. CORRESPONDENCE ADDRESS J.B. Osborn, Department of Surgery, Mayo Clinic, Rochester, MN, United States. SOURCE Annals of Surgical Oncology (2011) 18:11 (3204-3209). Date of Publication: October 2011 ISSN 1068-9265 1534-4681 (electronic) BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT Background: Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozensection analysis. Methods: A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support. Results: The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%. Conclusion: Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective. © Society of Surgical Oncology 2011. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost effectiveness analysis frozen section partial mastectomy EMTREE MEDICAL INDEX TERMS conference paper health care cost human institutional review intermethod comparison intraoperative period medicare reoperation surgical technique EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011676165 MEDLINE PMID 21861234 (http://www.ncbi.nlm.nih.gov/pubmed/21861234) PUI L51585316 DOI 10.1245/s10434-011-1956-0 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-011-1956-0 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 322 TITLE A patchwork of life: A bilingual breast cancer treatment patient decision aid targeted at medically underserved women AUTHOR NAMES Rustveld L. Jibaja-Weiss M. AUTHOR ADDRESSES (Rustveld L.; Jibaja-Weiss M.) Baylor College of Medicine, Houston, United States. CORRESPONDENCE ADDRESS L. Rustveld, Baylor College of Medicine, Houston, United States. SOURCE Cancer Epidemiology Biomarkers and Prevention (2011) 20:10 Meeting Abstracts. Date of Publication: September 2011 CONFERENCE NAME American Association for Cancer Research, AACR International Conference on the Science of Cancer Health Disparities 2011 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2011-09-18 to 2011-09-21 ISSN 1055-9965 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Most patient decision aids rely heavily on written information and require patients to have above average literacy skills, a potential barrier for the medically underserved. Individuals with limited literacy are restricted in their ability to make appropriate health decisions and to act on health information. We developed and evaluated the “A Patchwork of Life” (PLife) patient decision aid to assist medically underserved women with limited literacy in making a breast cancer treatment decision. The PLife is computer-based, culturally and linguistically appropriate learning environment that involves two key components, soap opera segments and related learning modules designed to support breast cancer (Stages I-IIIA) surgery decision-making and to encourage communication about treatment decision with their provider, relatives and friends. The objectives of the project were to: 1) determine the effectiveness of PLife in assisting patients make informed breast cancer treatment decisions, and; 2) evaluate patients' perceptions of the usefulness of the intervention for aiding in their decision-making. Experimental Procedures: The study was a randomized controlled trial including an intervention and control group. The intervention group viewed the PLife program and the control group received usual care including additional breast cancer educational material provided by the National Cancer Institute (NCI). Both groups consisted of patients who were candidates for lumpectomy or mastectomy. Patients were identified through pathology and other medical records and physician referrals. Those who consented completed all baseline assessments before implementation of the PLife decision aid. A Patient Navigator arranged for a convenient time for the patient to view the program. Immediately after viewing the program, patients answered a questionnaire rating the program. Follow-up data collection with patients took place via phone 2-weeks after viewing the program. At 2-week, and 6-month follow up patients answered questions about breast cancer knowledge, decisional conflict, and treatment preferences. Questionnaires were administered in Spanish and English. Summary of Data: A total of 100 patients diagnosed with Stage I-IIIA breast cancer were randomized to either a control (n = 49) or intervention group (n = 51). Median age of the sample was 49 ± 11.6 years, 15% were Non-Hispanic White, 56% African American, and 49% Hispanic. The majority of patients chose mastectomy over lumpectomy, regardless of study group assignment (60.8% intervention vs 53.1% control). Intervention group exhibited greater improvement in breast cancer knowledge compared to control group (60.5% vs 37.7%, respectively). At six month follow-up, patients who viewed the PLife program felt more informed about their treatment options, risks and benefits (p = 0.01), and showed significant improvement in decision certainty about breast cancer treatment (p = 0.01) compared to control group. Usability analysis revealed a high level of user satisfaction with the PLife program. Conclusions: Results suggest that the PLife program improved patients' knowledge about breast cancer. Additionally, patients who interacted with the PLife program exhibited an overall greater treatment decision certainty compared to usual care group. Taken together, these findings suggest, that the PLife program is a suitable strategy to help medically underserved women with breast cancer maximize their understanding of the implications of breast cancer treatment options. EMTREE DRUG INDEX TERMS soap EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer research cancer therapy female health disparity human medically underserved neoplasm patient EMTREE MEDICAL INDEX TERMS African American computer control group decision making follow up friend health Hispanic information processing interpersonal communication learning learning environment mastectomy medical information medical record national health organization partial mastectomy pathology physician procedures questionnaire randomized controlled trial reading risk satisfaction skill surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70707122 DOI 10.1158/1055-9965.DISP-11-A31 FULL TEXT LINK http://dx.doi.org/10.1158/1055-9965.DISP-11-A31 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 323 TITLE Evaluation of the clinical nurse specialist input into the breast reconstruction pathway at guys & st thomas' hospital foundation trust (GSTT): Adressing the unmet support needs of patients undergoing breast reconstruction AUTHOR NAMES Caseley J. Hopkirk L. AUTHOR ADDRESSES (Caseley J.; Hopkirk L.) Guys and St Thomas' NHS Foundation Trust, Oncology and Heamatology, London, United Kingdom. CORRESPONDENCE ADDRESS J. Caseley, Guys and St Thomas' NHS Foundation Trust, Oncology and Heamatology, London, United Kingdom. SOURCE European Journal of Cancer (2011) 47 SUPPL. 1 (S316-S317). Date of Publication: September 2011 CONFERENCE NAME 2011 European Multidisciplinary Cancer Congress CONFERENCE LOCATION Stockholm, Sweden CONFERENCE DATE 2011-09-23 to 2011-09-27 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Between April 2010 and April 2011, 250 patients underwent breast reconstruction at GSTT - A London cancer treatment centre. All patients diagnosed with breast cancer are offered immediate reconstruction at the time of initial surgery. It is acknowledged that women considering reconstruction have unmet emotional & physical needs as well as important goals and concerns that can affect their decisions about an experience of reconstruction. In particular, some breast cancer patients have unmet needs and are unprepared for the full effect of surgery on their lives & for the recovery process (Lee et al, 2010). The literature highlights the importance of being offered good information & support from the clinical nurse specialist at all stages of the reconstruction pathway (Ganz et al 1992, The National mastectomy & breast reconstruction audit, 2011). Materials and Methods: Both informal and formal patient feedback highlighted patients feeling isolated and unsupported following breast reconstruction. This led us to review the current patient pathway and CNS input at the reconstruction stage of the patient experience. Gaps in the service were highlighted which enabled us to define a very patient focused pathway whereby patients are supported at key points in the pathway by the CNS to assist with decision making and support needs following surgery. Result: Following review of the service, a structured nurse led pre assessment clinic has been set up with input from other allied health professionals to address the specific needs of a patient having immediate breast reconstruction. Conclusion: A service evaluation will be carried out on the new patient pathway with a patient questionnaire sent to all patients who have attended the pre assessment clinic examining their experience and support needs during their reconstruction pathway. The results of this will enable us to evaluate our current input into the service. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction clinical nurse specialist hospital human neoplasm non profit organization patient EMTREE MEDICAL INDEX TERMS breast cancer cancer patient cancer therapy central nervous system clinical audit decision making feedback system female health practitioner mastectomy nurse questionnaire surgery United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70548994 DOI 10.1016/S0959-8049(11)71395-8 FULL TEXT LINK http://dx.doi.org/10.1016/S0959-8049(11)71395-8 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 324 TITLE Implementing a breast cancer treatment patient decision aid in a medically underserved population in Texas AUTHOR NAMES Rustveld L. Jibaja-Weiss M. AUTHOR ADDRESSES (Rustveld L.; Jibaja-Weiss M.) Baylor College of Medicine, Houston, United States. CORRESPONDENCE ADDRESS L. Rustveld, Baylor College of Medicine, Houston, United States. SOURCE Cancer Epidemiology Biomarkers and Prevention (2011) 20:10 Meeting Abstracts. Date of Publication: September 2011 CONFERENCE NAME American Association for Cancer Research, AACR International Conference on the Science of Cancer Health Disparities 2011 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2011-09-18 to 2011-09-21 ISSN 1055-9965 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background: Decision aids are designed to help patients make informed decisions about medical treatment options. We developed and evaluated the effectiveness of culturally and linguistically appropriate breast cancer patient decision aid, “A Patchwork of Life” (PLife), targeted at medically underserved women with limited literacy. The PLife is a computer-based learning environment that involves two key components, soap opera segments and related learning modules designed to support breast cancer (Stages I-IIIA) surgery decision-making and to encourage communication about treatment decision with their provider, relatives and friends. The objectives of the current project are to implement the Plife program at one of the National Community Cancer Center Program (NCCCP) sites, in Austin Texas to: 1) evaluate the effectiveness of the implementation of the PLife program at the NCCCP clinic site by conducting an assessment of program outcomes with various stakeholders - patients, physicians, and patient navigator; 2) evaluate patients' and providers'perceptions of the usefulness of the intervention for aiding in their decision-making. Experimental Procedures: We will recruit 60 patients diagnosed with Stage I-IIIA breast cancer over 18 months. Patients will be identified through pathology and other medical records and physician referrals. Those who consent will complete all baseline assessments before implementation of the PLife decision aid. A Patient Navigator will arrange for a convenient time for the patient to view the program. Immediately after viewing the program, patients will answer a questionnaire rating the program. Follow-up data collection with patients will take place via phone 2-weeks after viewing the program. Measures to be collected at the 2-week follow up include breast cancer knowledge, decisional conflict, and treatment preferences, and provider perception questionnaires. Questionnaires will be administered in Spanish and English. Expected Results and Conclusions: The proposed project will enable the NCCCP site to significantly enhance breast cancer education, awareness and navigation for the underserved breast cancer patients who currently do not receive education or navigation services utilizing a tool that has been proven to assist patients with limited literacy in making informed breast cancer treatment decisions. EMTREE DRUG INDEX TERMS soap EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer research cancer therapy health disparity human medically underserved neoplasm patient population United States EMTREE MEDICAL INDEX TERMS cancer center cancer patient community computer decision making education female follow up friend hospital information processing interpersonal communication learning learning environment medical record pathology physician procedures questionnaire reading surgery therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70707123 DOI 10.1158/1055-9965.DISP-11-A32 FULL TEXT LINK http://dx.doi.org/10.1158/1055-9965.DISP-11-A32 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 325 TITLE Development of a decision aid and first impressions: A pilot study for older women with stage I hormone sensitive breast cancer AUTHOR NAMES D'Alimonte L. Szumacher E. Paszat L. Angus J. Gershman S. Metcalfe K. Llewellyn-Thomas H. Wong J. AUTHOR ADDRESSES (Szumacher E.; Paszat L.; Angus J.; Gershman S.; Metcalfe K.; Llewellyn-Thomas H.; Wong J.) (D'Alimonte L., Laura.Dalimonte@sunnybrook.ca) Odette Cancer Centre, Canada. CORRESPONDENCE ADDRESS L. D'Alimonte, Odette Cancer Centre, Canada. Email: Laura.Dalimonte@sunnybrook.ca SOURCE Journal of Medical Imaging and Radiation Sciences (2011) 42:3 (155-156). Date of Publication: September 2011 CONFERENCE NAME RTi3 2011: Inquire, Inspire, Innovate CONFERENCE LOCATION Toronto, ON, Canada CONFERENCE DATE 2011-03-04 to 2011-03-05 ISSN 1939-8654 BOOK PUBLISHER Elsevier Inc. ABSTRACT To develop a decision aid (DA) prototype for post lumpectomy women 70 years and older with Stage I hormone sensitive invasive breast cancer, and to conduct a preliminary testing of the DA to ensure that the format and information presented is clear and acceptable to patients. During the developmental phase of a prototype of the DA, we incorporated feedback from the focus groups that were conducted with 16 older women with Stage I breast cancer. In addition, we applied The Ottawa Decisional Support Framework to ensure that the information on the DA was evidence-based, practical, and understandable by the patients. The final format of the DA was evaluated in one-on-one interviews with 12 Stage I, breast cancer patients in the same age group. All the participants completed their adjuvant radiation therapy at the Odette Cancer Centre. After the interviews, the participants received a pocket size version of the DA and an acceptability questionnaire. The acceptability questionnaire investigated patients' understanding of the information provided, length of the DA, its visual appearance and the graphics. In addition, patients were encouraged to provide any further comments regarding the format and content of the DA prototype. All participants rated the DA as extremely acceptable, found the format and content clear and informative and had desired such a tool when they were facing their treatment decisions. Four (4/12) women felt that although theDAbooklet thoroughly presented all pertinent information, the content should be better organized. In addition, some women (4/12) felt that the language of the DA needed to be clarified and simplified for the lay audience who would be using the tool. The biggest concern from all participants was the timing of the delivery of the tool. Many women expressed the need for the tool to be administered prior to surgery or immediately after to allow for time to process the information presented in the DA and to generate questions for physician consults. Based on patients' feedback, we revised the content of the DA. We also simplified the language in several parts of the DA that was suggested by the participants. The detailed analysis of the acceptability questionnaires will be presented at the meeting. The findings of this study indicate that older breast cancer patients' informational needs are complex. The DA can be a helpful educational tool in the decision-making process for treatment in this group of low risk breast cancer patients. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hormone EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female human pilot study EMTREE MEDICAL INDEX TERMS cancer center cancer patient decision making evidence based practice feedback system groups by age information processing interview language partial mastectomy patient physician questionnaire radiotherapy risk surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70531779 DOI 10.1016/j.jmir.2011.06.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.jmir.2011.06.005 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 326 TITLE Enhancing decision making about participation in cancer clinical trials: Development of a question prompt list AUTHOR NAMES Brown R.F. Shuk E. Leighl N. Butow P. Ostroff J. Edgerson S. Tattersall M. AUTHOR ADDRESSES (Brown R.F., rbrown39@vcu.edu) Department of Social and Behavioral Health, Virginia Commonwealth University, School of Medicine, 1112 East Clay St, Richmond, VA 23298-0149, United States. (Shuk E.; Ostroff J.; Edgerson S.) Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY 10022, United States. (Leighl N.) Ontario Cancer Institute, Princess Margaret Hospital, 610 University Ave, Toronto, ON M5G 2M9, Canada. (Butow P.; Tattersall M.) Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, University of Sydney, Brennan/McCallum Building (A18), Sydney, NSW 2006, Australia. (Tattersall M.) Department of Cancer Medicine, School of Medicine, University of Sydney, Sydney, NSW 2006, Australia. CORRESPONDENCE ADDRESS R.F. Brown, Department of Social and Behavioral Health, Virginia Commonwealth University, School of Medicine, 1112 East Clay St, Richmond, VA 23298-0149, United States. Email: rbrown39@vcu.edu SOURCE Supportive Care in Cancer (2011) 19:8 (1227-1238). Date of Publication: August 2011 ISSN 0941-4355 1433-7339 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Purpose: Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician-patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). Method: Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients' decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. Results: Decision making was influenced by the outcome of patients' comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors' recommendation about the trial. Severity of a patient's disease influenced trial decision making only for trial-naive patients. Conclusion: Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion. © 2010 Springer-Verlag. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical trial (topic) decision making patient participation Question Prompt List questionnaire EMTREE MEDICAL INDEX TERMS adult aged article audio recording breast cancer cancer patient cancer staging clinical article consultation controlled study disease severity doctor patient relation education female human information processing intervention study lung cancer male marriage outcome assessment priority journal prostate cancer qualitative analysis risk benefit analysis risk factor trust tumor localization urogenital tract cancer EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011445037 MEDLINE PMID 20593202 (http://www.ncbi.nlm.nih.gov/pubmed/20593202) PUI L50975289 DOI 10.1007/s00520-010-0942-6 FULL TEXT LINK http://dx.doi.org/10.1007/s00520-010-0942-6 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 327 TITLE Entertainment education for breast cancer surgery decisions: A randomized trial among patients with low health literacy AUTHOR NAMES Jibaja-Weiss M.L. Volk R.J. Granchi T.S. Neff N.E. Robinson E.K. Spann S.J. Aoki N. Friedman L.C. Beck J.R. AUTHOR ADDRESSES (Jibaja-Weiss M.L., mariaj@bcm.edu; Neff N.E.) Department of Family and Community Medicine, Baylor College of Medicine, United States. (Volk R.J.) Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, Houston Center for Education and Research on Therapeutics, The University of Texas M.D. Anderson Cancer Center, United States. (Granchi T.S.) LLP, United States. (Robinson E.K.) Department of Surgery, The University of Texas Health Science Center, Houston, United States. (Spann S.J.; Beck J.R.) Baylor College of Medicine, United States. (Aoki N.) School of Health Information Sciences, The University of Texas Health Science Center, Houston, United States. (Aoki N.) Center for Health Service, Outcomes Research and Development-Japan (CHORDJ), Japan. (Friedman L.C.) Department of Psychiatry, Case Medical Center, University Hospitals Ireland Cancer Center, United States. (Beck J.R.) Office of the Vice President for Information Services, Fox Chase Cancer Center, United States. CORRESPONDENCE ADDRESS M.L. Jibaja-Weiss, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, United States. Email: mariaj@bcm.edu SOURCE Patient Education and Counseling (2011) 84:1 (41-48). Date of Publication: July 2011 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. Methods: Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. Results: Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. Conclusions: Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. Practice Implications: Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers). © 2010 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) computerized multimedia interactive patient decision aid health literacy multimedia patient decision making patient education EMTREE MEDICAL INDEX TERMS adult article controlled study decision making Decisional Conflict Scale early cancer female human informed consent knowledge mastectomy multicenter study partial mastectomy patient preference patient satisfaction priority journal public hospital randomized controlled trial rating scale surgical risk EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011322750 MEDLINE PMID 20609546 (http://www.ncbi.nlm.nih.gov/pubmed/20609546) PUI L50981533 DOI 10.1016/j.pec.2010.06.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2010.06.009 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 328 TITLE An exploration of patient decision-making for autologous breast reconstructive surgery following a mastectomy AUTHOR NAMES Begum S. Grunfeld E.A. Ho-Asjoe M. Farhadi J. AUTHOR ADDRESSES (Begum S.; Grunfeld E.A., beth.grunfeld@kcl.ac.uk) King's College London, Department of Psychology, Institute of Psychiatry, Guy's Hospital, London, United Kingdom. (Ho-Asjoe M.; Farhadi J.) GKT Cancer Reconstruction Service, St. Thomas' Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS E.A. Grunfeld, Section of Health Psychology, Psychology Department, Guy's Hospital, 5th Floor Bermondsey Wing, London SE1 9RT, United Kingdom. Email: beth.grunfeld@kcl.ac.uk SOURCE Patient Education and Counseling (2011) 84:1 (105-110). Date of Publication: July 2011 ISSN 0738-3991 1873-5134 (electronic) BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: The aim of this study was to examine patients' experiences of the decision to undergo breast reconstructive surgery following mastectomy. Method: 21 Women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants' experience of the decision-making process. The recorded interviews were transcribed verbatim and analyzed using " framework analysis" Results: Women who underwent immediate reconstruction spoke of the convenience of undergoing only one operation with regards to juggling work and childcare arrangements. For women who underwent delayed reconstructive surgery the reasons centre on dissatisfaction with wearing prosthesis. Others spoke of no choice, as immediate reconstruction was not offered as an option. However both groups did report similar influential factors and received and used similar informational content and informational sources in order to make their decision. Conclusion: The study outlines the different motivations for undergoing immediate or delayed breast reconstruction and highlights that there is not always a choice offered to patients. Practice implications: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos. © 2010 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction mastectomy patient decision making EMTREE MEDICAL INDEX TERMS access to information adult article breast prosthesis child care clinical article female human motivation patient information patient satisfaction priority journal semi structured interview EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011322759 MEDLINE PMID 20688457 (http://www.ncbi.nlm.nih.gov/pubmed/20688457) PUI L51017754 DOI 10.1016/j.pec.2010.07.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2010.07.004 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 329 TITLE Does use of the adjuvant! Model influence use of adjuvant therapy through better risk communication? AUTHOR NAMES Belkora J.K. Hutton D.W. Moore D.H. Siminoff L.A. AUTHOR ADDRESSES (Belkora J.K.) University of California San Francisco, San Francisco, CA, United States. (Hutton D.W., dwhutton@umich.edu) Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, United States. (Moore D.H.) Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States. (Siminoff L.A.) Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA, United States. CORRESPONDENCE ADDRESS D. W. Hutton, 1420 Washington Heights, Ann Arbor, MI 48109, United States. Email: dwhutton@umich.edu SOURCE JNCCN Journal of the National Comprehensive Cancer Network (2011) 9:7 (707-712). Date of Publication: 1 Jul 2011 ISSN 1540-1405 1540-1413 (electronic) BOOK PUBLISHER Harborside Press, 37 main Street, Cold Spring Harbor, United States. ABSTRACT Adjuvant! is a model that provides recurrence and mortality risk predictions for patients with breast cancer considering adjuvant therapies. Although low-risk patients who saw Adjuvant! chose adjuvant therapy less frequently, whether this was because of educational or other aspects of the decision aid is unknown. The authors explored whether Adjuvant! affects choice of therapy through increased patient knowledge. A subset of data were analyzed from a cluster randomized trial in which oncology practices in 2 major United States cities were randomly assigned to use either Adjuvant! or an informational pamphlet to educate patients. Of 405 patients, 48 were low-risk, with 28 assigned to the decision aid and 20 to the pamphlet. Among the low-risk patients, using frequency tables and Fisher exact tests, the authors explored whether Adjuvant! was associated with more accurate patient estimates of survival; whether accuracy was associated with treatment choice; and whether, after controlling for accuracy, any remaining association was seen between Adjuvant! and treatment choice. Adjuvant! was associated with more accurate estimates of baseline prognosis compared with the pamphlet (57% vs. 25%; P = .04). Patients who had more accurate estimates of baseline prognosis were less likely to choose adjuvant therapy (62% vs. 89%; P = .04). After controlling for accuracy, no statistically significant association was found between the use of Adjuvant! and adjuvant therapy (P = .59 and P = .11 for inaccurate and accurate patients, respectively). Adjuvant! seems to influence patient choice through educational rather than other means of persuasion. However, many patients held inaccurate risk perceptions after viewing Adjuvant!. © JNCCN-Journal of the National Comprehensive Cancer Network. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer risk assessment EMTREE MEDICAL INDEX TERMS cancer adjuvant therapy cancer risk cancer survival decision making female Fisher exact test human major clinical study patient education patient preference review EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011375444 MEDLINE PMID 21715722 (http://www.ncbi.nlm.nih.gov/pubmed/21715722) PUI L362098785 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 330 TITLE Selective application of routine preoperative axillary ultrasonography reduces costs for invasive breast cancers AUTHOR NAMES Turaga K.K. Chau A. Eatrides J.M. Kiluk J.V. Khakpour N. Laronga C. Lee M.C. AUTHOR ADDRESSES (Turaga K.K.) Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, United States. (Turaga K.K.; Kiluk J.V.; Khakpour N.; Laronga C.; Lee M.C., Marie.Lee@Moffitt.org) Department of Women's Oncology, Tampa, FL, United States. (Chau A.) Division of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States. (Kiluk J.V.; Khakpour N.; Laronga C.; Lee M.C., Marie.Lee@Moffitt.org) Departments of Oncologic Sciences and Surgery, Tampa, FL, United States. (Eatrides J.M.) University of South Florida College of Medicine, Tampa, FL, United States. CORRESPONDENCE ADDRESS M. C. Lee, Department of Women's Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive BR-PROG, Tampa, FL 33612, United States. Email: Marie.Lee@Moffitt.org SOURCE Oncologist (2011) 16:7 (942-948). Date of Publication: July 2011 ISSN 1083-7159 1549-490X (electronic) BOOK PUBLISHER AlphaMed Press, 318 Blackwell St. Suite 260, Durham, United States. ABSTRACT Purpose. Preoperative axillary sonography with fine needle aspiration (FNA) in patients with invasive breast cancer identifies patients with nodal metastasis who can be spared further surgery. Indiscriminate use of the diagnostic modality can increase costs and yield inaccurate results. We evaluate the costs associated with the use of highly sensitive axillary ultrasonography in patients with stage >T2 tumors. Patients and Methods. We constructed a decision analysis tree using TreeAge Pro 2009 software comparing direct hospital charges between patients with and without routine use of axillary ultrasound. Base case estimates were derived from our institutional data and compared with those derived from the literature. One- and two-way sensitivity analyses were performed to check the validity of our inferences. © AlphaMed Press. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, surgery) echomammography health care cost EMTREE MEDICAL INDEX TERMS article cancer staging controlled study cost benefit analysis data analysis software decision making female fine needle aspiration biopsy hospital charge human major clinical study mastectomy metastasis preoperative period priority journal reimbursement retrospective study sensitivity analysis sensitivity and specificity sentinel lymph node biopsy systematic review DEVICE TRADE NAMES TreeAge Pro 2009 , United StatesTreeAge Software DEVICE MANUFACTURERS (United States)TreeAge Software EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011416025 MEDLINE PMID 21572122 (http://www.ncbi.nlm.nih.gov/pubmed/21572122) PUI L362231932 DOI 10.1634/theoncologist.2010-0373 FULL TEXT LINK http://dx.doi.org/10.1634/theoncologist.2010-0373 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 331 TITLE Satisfaction with ovarian carcinoma risk-reduction strategies among women at high risk for breast and ovarian carcinoma AUTHOR NAMES Westin S.N. Sun C.C. Lu K.H. Schmeler K.M. Soliman P.T. Lacour R.A. Johnson K.G. Daniels M.S. Arun B.K. Peterson S.K. Bodurka D.C. AUTHOR ADDRESSES (Westin S.N.; Sun C.C.; Lu K.H.; Schmeler K.M.; Soliman P.T.; Lacour R.A.; Johnson K.G.; Daniels M.S.; Bodurka D.C., dcbodurka@mdanderson.org) Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States. (Arun B.K.) Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Peterson S.K.) Department of Clinical Cancer Genetics, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. CORRESPONDENCE ADDRESS D. C. Bodurka, Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States. Email: dcbodurka@mdanderson.org SOURCE Cancer (2011) 117:12 (2659-2667). Date of Publication: 15 Jun 2011 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND: Women who are at high risk for breast and ovarian cancer have 2 major management options to reduce their risk of ovarian cancer: periodic screening (PS) or risk-reducing salpingo-oophorectomy (RRSO). Little is known regarding patient satisfaction levels with risk-reduction strategies. Thus, the authors sought to determine levels of patient satisfaction with PS versus RRSO and to identify factors that may influence satisfaction. METHODS: As part of a larger study, women who received testing for the breast cancer genes BRCA1 and BRCA2 were sent a follow-up questionnaire packet to explore issues related to cancer risk reduction. The authors report on the results from a variety of validated instruments, including the Satisfaction With Decision (SWD) scale, focused on the choice between PS and RRSO. RESULTS: In total, 544 surveys were mailed, and 313 responses were received (58%). The overall satisfaction rate among respondents was high. The median SWD score was significantly higher in the RRSO group compared with the PS group (P <.001). BRCA mutation carriers had higher median SWD scores regardless of management type (P =.01). Low satisfaction scores were associated with high levels of uncertainty and the perception that the decision between PS and RRSO was difficult to make (P =.001). Satisfaction was unrelated to demographics, clinical factors, or concerns of cancer risk. CONCLUSIONS: In the current study, the majority of women who were at high risk for breast and ovarian cancer were satisfied with their choice of risk-reduction strategy. Difficulty with decision making was associated with lower satisfaction levels. Improved education and support through the decision-making process may enhance overall levels of satisfaction. Copyright © 2010 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer ovary cancer patient satisfaction risk reduction EMTREE MEDICAL INDEX TERMS adult aged article cancer risk cancer screening controlled study female gene expression gene mutation high risk patient human major clinical study patient decision making priority journal salpingooophorectomy tumor suppressor gene EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011325377 MEDLINE PMID 21656744 (http://www.ncbi.nlm.nih.gov/pubmed/21656744) PUI L361942983 DOI 10.1002/cncr.25820 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.25820 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 332 TITLE Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. AUTHOR NAMES Caldon L.J. Collins K.A. Reed M.W. Sivell S. Austoker J. Clements A.M. Patnick J. Elwyn G. BresDex Group AUTHOR ADDRESSES (Caldon L.J.) Department of Oncology, University of Sheffield, Sheffield, UK. (Collins K.A.; Reed M.W.; Sivell S.; Austoker J.; Clements A.M.; Patnick J.; Elwyn G.; BresDex Group) CORRESPONDENCE ADDRESS L.J. Caldon, Department of Oncology, University of Sheffield, Sheffield, UK. Email: l.caldon@sheffield.ac.uk SOURCE Health expectations : an international journal of public participation in health care and health policy (2011) 14:2 (133-146). Date of Publication: Jun 2011 ISSN 1369-7625 (electronic) ABSTRACT There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. © 2010 Blackwell Publishing Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system health personnel attitude mastectomy patient education physician EMTREE MEDICAL INDEX TERMS article doctor patient relation female human Internet interview male methodology psychological aspect United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 21029281 (http://www.ncbi.nlm.nih.gov/pubmed/21029281) PUI L560014554 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 333 TITLE Decision aids for breast and nodal surgery in patients with early breast cancer: Development and a pilot study AUTHOR NAMES Harwood R. Douglas C. Clark D. AUTHOR ADDRESSES (Harwood R., rachael.c.harwood@studentmail.newcastle.edu.au; Douglas C.) Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia. (Douglas C.; Clark D.) The Breast Centre, Newcastle, NSW, Australia. CORRESPONDENCE ADDRESS R. Harwood, 2/50 Flett St, Taree, NSW 2430, Australia. Email: rachael.c.harwood@studentmail.newcastle.edu.au SOURCE Asia-Pacific Journal of Clinical Oncology (2011) 7:2 (114-122). Date of Publication: June 2011 ISSN 1743-7555 1743-7563 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Aim: As survival rates for aggressive and conservative breast and lymph node surgery are similar, surgical treatment decisions for patients with early-stage breast cancer should take patient preference into account. Decision aids have been demonstrated to increase patient knowledge and satisfaction with decision making, while decreasing decisional conflict. Hundreds of decision aids exist; however, few address lymph node surgery in any detail, and none acknowledge that there is a choice comparable to that between mastectomy and breast-conserving therapy. Methods: A systematic process was employed to develop decision aids for mastectomy versus breast-conserving therapy, axillary dissection versus sentinel node biopsy, and options following a positive sentinel node biopsy. The first two of these decision aids were evaluated in a small pilot study. Choice of operation, knowledge and decisional conflict and satisfaction were compared with outcomes in an historical control group. Results: Women reported favorably on the decision aids. The numbers in the pilot group were too small to allow definitive conclusions to be drawn, but suggested a possible reduction in decisional conflict, and possibly increase in decisional satisfaction, knowledge and choice of axillary clearance (rather than sentinel node biopsy) in the intervention group. Conclusion: These decision aids could improve decision making for the surgical treatment of early breast cancer. A prospective randomized, control trial is needed to further evaluate the impact of these decision aids, particularly in the case of nodal surgery. © 2011 Blackwell Publishing Asia Pty Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast surgery early cancer (surgery) lymph node dissection EMTREE MEDICAL INDEX TERMS adult article axillary lymph node clinical article clinical decision making comparative study controlled study female human intermethod comparison mastectomy partial mastectomy patient satisfaction pilot study priority journal randomized controlled trial sentinel lymph node biopsy EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011277484 MEDLINE PMID 21585690 (http://www.ncbi.nlm.nih.gov/pubmed/21585690) PUI L51248791 DOI 10.1111/j.1743-7563.2010.01375.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1743-7563.2010.01375.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 334 TITLE Development and evaluation of a decision aid for BRCA carriers with breast cancer. AUTHOR NAMES Culver J.O. MacDonald D.J. Thornton A.A. Sand S.R. Grant M. Bowen D.J. Burke H. Garcia N. Metcalfe K.A. Weitzel J.N. AUTHOR ADDRESSES (Culver J.O.) Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010-3000, USA. (MacDonald D.J.; Thornton A.A.; Sand S.R.; Grant M.; Bowen D.J.; Burke H.; Garcia N.; Metcalfe K.A.; Weitzel J.N.) CORRESPONDENCE ADDRESS J.O. Culver, Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010-3000, USA. Email: jculver@coh.org SOURCE Journal of genetic counseling (2011) 20:3 (294-307). Date of Publication: Jun 2011 ISSN 1573-3599 (electronic) ABSTRACT BRCA+ breast cancer patients face high risk for a second breast cancer and ovarian cancer. Helping these women decide among risk-reducing options requires effectively conveying complex, emotionally-laden, information. To support their decision-making needs, we developed a web-based decision aid (DA) as an adjunct to genetic counseling. Phase 1 used focus groups to determine decision-making needs. These findings and the Ottawa Decision Support Framework guided the DA development. Phase 2 involved nine focus groups of four stakeholder types (BRCA+ breast cancer patients, breast cancer advocates, and genetics and oncology professionals) to evaluate the DA's decision-making utility, information content, visual display, and implementation. Overall, feedback was very favorable about the DA, especially a values and preferences ranking-exercise and an output page displaying personalized responses. Stakeholders were divided as to whether the DA should be offered at-home versus only in a clinical setting. This well-received DA will be further tested to determine accessibility and effectiveness. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system heterozygote detection tumor suppressor gene EMTREE MEDICAL INDEX TERMS article female genetic counseling genetics human information processing mastectomy ovariectomy psychological aspect risk reduction LANGUAGE OF ARTICLE English MEDLINE PMID 21369831 (http://www.ncbi.nlm.nih.gov/pubmed/21369831) PUI L362383736 DOI 10.1007/s10897-011-9350-4 FULL TEXT LINK http://dx.doi.org/10.1007/s10897-011-9350-4 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 335 TITLE Preoperative patient education for breast reconstruction: a systematic review of the literature. AUTHOR NAMES Preminger B.A. Lemaine V. Sulimanoff I. Pusic A.L. McCarthy C.M. AUTHOR ADDRESSES (Preminger B.A.) Plastic and Reconstructive Surgery, Department of Surgery, Columbia University, The Affiliation at Harlem Hospital, 506 Lenox Ave, New York, NY 10037, USA. (Lemaine V.; Sulimanoff I.; Pusic A.L.; McCarthy C.M.) CORRESPONDENCE ADDRESS B.A. Preminger, Plastic and Reconstructive Surgery, Department of Surgery, Columbia University, The Affiliation at Harlem Hospital, 506 Lenox Ave, New York, NY 10037, USA. SOURCE Journal of cancer education : the official journal of the American Association for Cancer Education (2011) 26:2 (270-276). Date of Publication: Jun 2011 ISSN 1543-0154 (electronic) ABSTRACT This study aims to assess the current state of patient educational tools available for the purposes of educating women about postmastectomy breast reconstruction. A systematic review of the English language literature was conducted between the years 1966 and 2009 of all studies pertaining to the use of educational materials for breast reconstruction. MEDLINE, CINAHAL, PsycINFO, EMBASE, SCOPUS, and the Science Citation Index were searched. Only studies that both employed and evaluated a patient educational tool in the setting of postmastectomy reconstruction were selected for review. Qualifying studies were then evaluated with respect to their study design, sample size, and outcome measure evaluated. Each educational tool identified was similarly evaluated with respect to its development process, content, and educational medium. A total of 497 articles were retrieved. Of these, only seven met our inclusion criteria. These publications evaluated a total of seven educational tools. Among them were employed various mediums including written, visual, and audio materials. Detailed review revealed that the development of only one educational program included an educational needs assessment. Only two of the seven studies identified evaluated the efficacy of their educational tool using a randomized controlled trial study design. Outcome measures evaluated varied among the studies identified and included: knowledge gains (n = 4), the 'yes' or 'no' decision to undergo reconstruction (n = 3), satisfaction with decision regarding reconstruction (n = 1), decisional conflict (n = 3), and type of reconstruction (n = 3). This review highlights the need for well-designed, methodologically sound research into patient education regarding breast reconstruction. Such information is invaluable in developing patient education programs and decision aids that aim at patient empowerment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction patient education EMTREE MEDICAL INDEX TERMS decision making female human methodology preoperative care review LANGUAGE OF ARTICLE English MEDLINE PMID 21181326 (http://www.ncbi.nlm.nih.gov/pubmed/21181326) PUI L362650236 DOI 10.1007/s13187-010-0182-y FULL TEXT LINK http://dx.doi.org/10.1007/s13187-010-0182-y COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 336 TITLE The complexity of breast cancer risk needs to be embraced, not oversimplified AUTHOR NAMES Hughes K.S. Roche C.A. AUTHOR ADDRESSES (Hughes K.S.; Roche C.A.) Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States. CORRESPONDENCE ADDRESS K. S. Hughes, Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States. SOURCE Menopause (2011) 18:6 (599-600). Date of Publication: June 2011 ISSN 1072-3714 1530-0374 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE DRUG INDEX TERMS BRCA1 protein BRCA2 protein raloxifene tamoxifen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, prevention) cancer risk EMTREE MEDICAL INDEX TERMS breast carcinoma breast hyperplasia cancer chemotherapy carcinoma in situ chemoprophylaxis decision support system disease carrier editorial family history gene mutation genetic screening hereditary tumor high risk patient mammography mastectomy nuclear magnetic resonance imaging ovary cancer patient identification risk management thorax radiography CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011326755 MEDLINE PMID 21587090 (http://www.ncbi.nlm.nih.gov/pubmed/21587090) PUI L51428802 DOI 10.1097/gme.0b013e31821bbd55 FULL TEXT LINK http://dx.doi.org/10.1097/gme.0b013e31821bbd55 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 337 TITLE Predictors of successful breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS) AUTHOR NAMES Griggs J.J. Sorbero M.E. Ahrendt G.M. Schiffhauer L.M. Stark A. Dick A.W. AUTHOR ADDRESSES (Griggs J.J.; Sorbero M.E.; Ahrendt G.M.; Schiffhauer L.M.; Stark A.; Dick A.W.) University of Michigan, Ann Arbor, United States. (Griggs J.J.; Sorbero M.E.; Ahrendt G.M.; Schiffhauer L.M.; Stark A.; Dick A.W.) RAND Corporation, Pittsburgh, United States. (Griggs J.J.; Sorbero M.E.; Ahrendt G.M.; Schiffhauer L.M.; Stark A.; Dick A.W.) University of Pittsburgh Medical Center, Pittsburgh, United States. (Griggs J.J.; Sorbero M.E.; Ahrendt G.M.; Schiffhauer L.M.; Stark A.; Dick A.W.) University of Rochester Medical Center, Rochester, United States. (Griggs J.J.; Sorbero M.E.; Ahrendt G.M.; Schiffhauer L.M.; Stark A.; Dick A.W.) Department of Pathology, Henry Ford Health System, Detroit, United States. CORRESPONDENCE ADDRESS J.J. Griggs, University of Michigan, Ann Arbor, United States. SOURCE Journal of Clinical Oncology (2011) 29:15 SUPPL. 1. Date of Publication: 20 May 2011 CONFERENCE NAME ASCO Annual Meeting 2011 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2011-06-03 to 2011-06-07 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Patients with DCIS who prefer breast preservation may ultimately require mastectomy to achieve optimal local control. The objectives of this study were to identify factors that were predictive of successful BCS and to develop a simple index to aid in surgical decision making. Methods: We defined the dependent variable, “successful BCS,” as preservation of the breast with negative margins (more than 2 mm). Detailed clinical, pathologic, and demographic data were ed from medical records of patients with DCIS over a 15-year period in two registries (N = 1,031). We first estimated logistic regression models to identify factors associated with successful BCS in patients whose first therapeutic procedure was a breast conserving procedure. We then estimated a similar logistic regression model controlling for the number of “positive” and “negative” predictors of success and used these estimates to create an index of successful BCS. Results: The logistic regression models fit well and showed excellent discrimination (C-statistic = 0.78; Hosmer-Lemeshow, p=0.31). Factors found to be positively predictive of successful BCS were tumor size under 0.5 cm, cribriform histology, low nuclear grade, mammographic detection, and age of 65 or older. Factors found to be negatively predictive of successful BCS were positive margins after the first therapeutic procedure, extensive disease, multifocal disease, comedo histology, a positive family history, tumor size over 1.5 cm or unspecified, and age less than 40 years. The matrix below shows predicted probabilities of successful BCS based on the second logistic regression model estimates that included only the number of positive and negative predictors. Conclusions: If confirmed in other patient samples, this predictive index could serve as the foundation of a decision aid, benefitting patients and providers by decreasing multiple attempts at breast conservation in patients unlikely to achieve successful BCS. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intraductal carcinoma partial mastectomy patient EMTREE MEDICAL INDEX TERMS breast comedo decision making dependent variable family history histology logistic regression analysis mastectomy medical record model non profit organization preservation procedures register tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70710891 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 338 TITLE Preoperative breast MRI in early-stage breast cancer: A decision analysis. AUTHOR NAMES Young P. Kim B. Malin J. AUTHOR ADDRESSES (Young P.; Kim B.; Malin J.) Cedars-Sinai Medical Center, Los Angeles, United States. (Young P.; Kim B.; Malin J.) David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, United States. (Young P.; Kim B.; Malin J.) Greater Los Angeles Veterans Administration Health Care System, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, United States. CORRESPONDENCE ADDRESS P. Young, Cedars-Sinai Medical Center, Los Angeles, United States. SOURCE Journal of Clinical Oncology (2011) 29:15 SUPPL. 1. Date of Publication: 20 May 2011 CONFERENCE NAME ASCO Annual Meeting 2011 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2011-06-03 to 2011-06-07 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Rapid uptake of new imaging technology is a major contributor to rising health care costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without evidence of improved outcomes compared to standard triple assessment (clinical examination, imaging with mammography and/or ultrasonography, and needle biopsy) and is associated with higher rates of mastectomy. Methods: A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy (BCT) on patient outcome measures in quality-adjusted-life-years (QALYs). Model inputs including survival, recurrence rates, and health utilities were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard triple assessment. Results: Preoperative breast MRI was associated with a decrease of 0.094 QALYs compared with no MRI, based on a 20-year life expectancy after diagnosis of early-stage breast cancer. In order for routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1% (vs. range of 3.6-54% reported in the literature) Across a wide range of local recurrence rates following BCT, MRI remained inferior to no MRI. Conclusions: Routine preoperative breast MRI appears to confer no advantage over standard diagnostic evaluations for early-stage breast cancer and may lead to worse outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer nuclear magnetic resonance imaging EMTREE MEDICAL INDEX TERMS clinical examination diagnosis echography female health health care cost human imaging life expectancy mammography mastectomy model needle biopsy parameters patient preoperative evaluation quality adjusted life year recurrence risk sensitivity analysis survival technology therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70710983 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 339 TITLE Why do hospital mastectomy rates vary Differences in the decision-making experiences of women with breast cancer AUTHOR NAMES Caldon L.J.M. Collins K.A. Wilde D.J. Ahmedzai S.H. Noble T.W. Stotter A. Sibbering D.M. Holt S. Reed M.W.R. AUTHOR ADDRESSES (Caldon L.J.M., l.caldon@sheffield.ac.uk; Wilde D.J.; Ahmedzai S.H.; Noble T.W.; Reed M.W.R.) Department of Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, United Kingdom. (Collins K.A.) Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield S10 2BP, United Kingdom. (Stotter A.) University Hospitals of Leicester, Glenf Ield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom. (Sibbering D.M.) Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, United Kingdom. (Holt S.) Chesterf Ield Royal Hospital NHS Foundation Trust, Calow, Chesterf ield S44 5BL, United Kingdom. CORRESPONDENCE ADDRESS L. J. M. Caldon, Department of Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, United Kingdom. Email: l.caldon@sheffield.ac.uk SOURCE British Journal of Cancer (2011) 104:10 (1551-1557). Date of Publication: 10 May 2011 ISSN 0007-0920 1532-1827 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Background:Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients consultation and decision-making experiences with specialist clinicians.Methods:Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.Results:Low mastectomy rate unit patients consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT.Conclusion:Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making. © 2011 Cancer Research UK All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) mastectomy medical decision making EMTREE MEDICAL INDEX TERMS adult aged article breast conservation therapy breast surgery conservative treatment consultation controlled study female human major clinical study medical specialist patient autonomy patient participation priority journal EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011259891 MEDLINE PMID 21559024 (http://www.ncbi.nlm.nih.gov/pubmed/21559024) PUI L361743636 DOI 10.1038/bjc.2011.141 FULL TEXT LINK http://dx.doi.org/10.1038/bjc.2011.141 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 340 TITLE Longitudinal changes in patient distress following interactive decision aid use among BRCA1/2 carriers: a randomized trial. AUTHOR NAMES Hooker G.W. Leventhal K.G. DeMarco T. Peshkin B.N. Finch C. Wahl E. Joines J.R. Brown K. Valdimarsdottir H. Schwartz M.D. AUTHOR ADDRESSES (Hooker G.W.) Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. (Leventhal K.G.; DeMarco T.; Peshkin B.N.; Finch C.; Wahl E.; Joines J.R.; Brown K.; Valdimarsdottir H.; Schwartz M.D.) CORRESPONDENCE ADDRESS G.W. Hooker, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. SOURCE Medical decision making : an international journal of the Society for Medical Decision Making (2011) 31:3 (412-421). Date of Publication: 2011 May-Jun ISSN 1552-681X (electronic) ABSTRACT Increasingly, women with a strong family history of breast cancer are seeking genetic testing as a starting point to making significant decisions regarding management of their cancer risks. Individuals who are found to be carriers of a BRCA1 or BRCA2 mutation have a substantially elevated risk for breast cancer and are frequently faced with the decision of whether to undergo risk-reducing mastectomy. In order to provide BRCA1/2 carriers with ongoing decision support for breast cancer risk management, a computer-based interactive decision aid was developed and tested against usual care in a randomized controlled trial. . Following genetic counseling, 214 female (aged 21-75 years) BRCA1/2 mutation carriers were randomized to usual care (UC; n = 114) or usual care plus decision aid (DA; n = 100) arms. UC participants received no further intervention; DA participants were sent the CD-ROM-based decision aid to view at home. The authors measured general distress, cancer-specific distress, and genetic testing-specific distress at 1-, 6-, and 12-month follow-up time points postrandomization. Longitudinal analyses revealed a significant longitudinal impact of the DA on cancer-specific distress (B = 5.67, z = 2.81, P = 0.005), which varied over time (DA group by time; B = -2.19, z = -2.47, P = 0.01), and on genetic testing-specific distress (B = 5.55, z = 2.46, P = 0.01), which also varied over time (DA group by time; B = -2.46, z = -2.51, P = 0.01). Individuals randomized to UC reported significantly decreased distress in the month following randomization, whereas individuals randomized to the DA maintained their postdisclosure distress over the short term. By 12 months, the overall decrease in distress between the 2 groups was similar. This report provides new insight into the long-term longitudinal effects of DAs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system genetic counseling mental stress EMTREE MEDICAL INDEX TERMS adaptive behavior adult aged article clinical trial controlled clinical trial controlled study female genetics human longitudinal study mammography mastectomy middle aged multivariate analysis patient education psychological aspect psychometry questionnaire randomized controlled trial risk assessment time tumor suppressor gene United States (epidemiology) LANGUAGE OF ARTICLE English MEDLINE PMID 20876346 (http://www.ncbi.nlm.nih.gov/pubmed/20876346) PUI L362650279 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 341 TITLE Willingness to pay and cost benefit analysis of delivery methods for decision support for rural cancer patients AUTHOR NAMES Wilson L.S. Loucks A. Franklin L. O'Donnell S. Moore D. Jupiter C. Kong S. Yeung R. Belkora J. AUTHOR ADDRESSES (Wilson L.S.; Loucks A.; Franklin L.; Moore D.; Kong S.; Yeung R.; Belkora J.) University of California San Francisco, San Francisco, United States. (O'Donnell S.; Jupiter C.) Cancer Resource Centers of Mendocino County, Mendocino, United States. CORRESPONDENCE ADDRESS L.S. Wilson, University of California San Francisco, San Francisco, United States. SOURCE Value in Health (2011) 14:3 (A163). Date of Publication: May 2011 CONFERENCE NAME 16th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research, ISPOR 2011 CONFERENCE LOCATION Baltimore, MD, United States CONFERENCE DATE 2011-05-21 to 2011-05-25 ISSN 1098-3015 BOOK PUBLISHER Elsevier Ltd ABSTRACT OBJECTIVES: Consultation planning (CP), a decision support service for patients provided by trained lay people, increases cancer patient's decision-self-efficacy (DSE) when conducted in-person. It may be more cost-beneficial to conduct CP by telephone. Compare DSE, costs,willingness-to-pay (WTP) and cost-benefit (CBA) of two CP delivery methods in rural breast cancer patients. METHODS: Randomly assigned clients from cancer resource centers were enrolled (n=67). Interventions were CP in-person (n=32) or by telephone (n=35) between patients and trained resource center staff to discuss knowledge for informed care decisions at their next physician visit. Outcomeswere DSE andWTP for services. 2009 costs of training, CP and patient time, travel, telephone, and center overhead were determined. We compared costs and WTP using t-tests, ranked-sum or Kolmogorov-Smirnov tests depending on Shapiro-Wilk tests for normality. CBA compared net benefit and CB ratios for deliverymethods. RESULTS: As hypothesized, DSE did not differ between deliverymethods (mean=3.44 in-person;3.54 telephone) but each improved significantly (p<0.001). Patients' WTP did not differ by method; telephone ($154), inperson ($144) (p<0.78). Intervention costs were significantly lower for telephone than in-person ($139 vs $181,p<0.001) due to higher patient travel for in-person ($26 vs $2,p<0.001). Training costs were $5.78-$147/person depending on amortization volume. Net benefit for telephone over in-person is $52; $42 less cost, with $10 more value. CB ratios when training ($6.00-$147/patient) and overhead ($25/ patient) are added to program costs are 0.41-0.68 for in-person and 0.49-0.90 for telephone depending on number delivered, so patients are WTP up to 68% of inperson and 90% of telephone costs; 22% more return-on-investment for telephone CP. CONCLUSIONS: Telephone delivery is more cost-beneficial than in-person CP. The value of CP is the same for eithermethod and there are significant cost savings with telephone delivery. Adoption of CP by telephone could result in additional access for rural patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient cost benefit analysis decision support system outcomes research pharmacoeconomics society EMTREE MEDICAL INDEX TERMS breast cancer consultation cost control human investment Kolmogorov Smirnov test neoplasm patient physician planning self concept Student t test telephone travel LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70491306 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 342 TITLE Pharmacoeconomic aspects of oral cytostatic agents ORIGINAL (NON-ENGLISH) TITLE Aspectos farmacoeconómicos de los citostáticos orales AUTHOR NAMES Jornet J.E.P. Carrera-Hueso F.J. Blesa J.M.G. Godoy M.P. AUTHOR ADDRESSES (Jornet J.E.P., jaime.poquet@marinasalud.es; Godoy M.P.) Jefe del Área Clínica de Farmacia, Hospital de Denia, Denia, Alicante, Spain. (Carrera-Hueso F.J.) Servicio de Farmacia, Hospital Dr. Moliner, Serra, Valencia, Spain. (Blesa J.M.G.) Jefe del Área Clínica de Oncología, Hospital de Denia, Denia, Alicante, Spain. CORRESPONDENCE ADDRESS J.E.P. Jornet, Jefe del Área Clínica de Farmacia, Hospital de Denia, Denia, Alicante, Spain. Email: jaime.poquet@marinasalud.es SOURCE Farmacia Hospitalaria (2011) 35:SUPPL. 2 (25-31). Date of Publication: May 2011 ISSN 1130-6343 2171-8695 (electronic) BOOK PUBLISHER ARAN Ediciones S.A., Castello 128 - 1o, Madrid, Spain. ABSTRACT When validating oral chemotherapy, pharmacists should confirm the suitability and correctness of the prescription, applying the same safety standards as those used for parenteral cytostatic drugs. There are an increasing number of cancers for which orally administered drugs are available, which increases patient satisfaction as these drugs can be taken at home without the need to visit a hospital. As oral cytostatic treatments increase, so does the importance of ensuring optimal treatment compliance. The new oral cytostatic agents are less toxic, reduce indirect costs and imply less loss of time for patients and their families. However, the cost of these agents should be below a threshold acceptable for society. As an aid to decision making, pharmacoeconomic tools should be used. © 2011 SEFH. Published by Elsevier España, S.L. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cytostatic agent (intravenous drug administration, oral drug administration, parenteral drug administration, pharmacoeconomics, pharmacokinetics) EMTREE DRUG INDEX TERMS anthracycline derivative (drug therapy, pharmacoeconomics) anticonvulsive agent (drug interaction) bevacizumab (drug combination, drug therapy, pharmacoeconomics) capecitabine (adverse drug reaction, drug combination, drug therapy, intravenous drug administration, oral drug administration, pharmacoeconomics) carbamazepine (drug interaction) cetuximab (drug combination, drug therapy, pharmacoeconomics) ciprofloxacin (drug interaction) cisplatin (drug therapy, pharmacoeconomics) docetaxel (drug combination, drug therapy, pharmacoeconomics) erlotinib (drug interaction, drug therapy, pharmacoeconomics) etoposide (oral drug administration, pharmacokinetics) fluorouracil (drug combination, drug therapy, pharmacoeconomics) folinic acid (drug combination, drug therapy, pharmacoeconomics) gemcitabine (drug therapy, pharmacoeconomics) imatinib (drug interaction) irinotecan (drug combination, drug therapy, pharmacoeconomics) itraconazole (drug interaction) lapatinib (drug combination, drug therapy, pharmacoeconomics) lomustine oxaliplatin (drug combination, drug therapy, pharmacoeconomics) paclitaxel (oral drug administration, pharmacokinetics) pemetrexed (drug combination, drug therapy, pharmacoeconomics) phenobarbital (drug interaction) phenytoin (drug interaction) taxane derivative (drug therapy, pharmacoeconomics) topotecan (oral drug administration, pharmacokinetics) trastuzumab (pharmacoeconomics) unindexed drug vinorelbine tartrate (drug therapy, oral drug administration, pharmacoeconomics, pharmacokinetics) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient compliance pharmacoeconomics EMTREE MEDICAL INDEX TERMS article bone marrow suppression (side effect) breast cancer (drug therapy) cancer chemotherapy clinical protocol colon cancer (disease management, drug therapy) colorectal cancer (drug therapy) cost benefit analysis cost effectiveness analysis drug cost drug dose regimen drug safety gastrointestinal symptom (side effect) human lung cancer (drug therapy) medical decision making patient satisfaction pharmacist prescription stomach cancer (drug therapy) time CAS REGISTRY NUMBERS bevacizumab (216974-75-3) capecitabine (154361-50-9) carbamazepine (298-46-4, 8047-84-5) cetuximab (205923-56-4) ciprofloxacin (85721-33-1) cisplatin (15663-27-1, 26035-31-4, 96081-74-2) docetaxel (114977-28-5) erlotinib (183319-69-9, 183321-74-6) etoposide (33419-42-0) fluorouracil (51-21-8) folinic acid (58-05-9) gemcitabine (103882-84-4) imatinib (152459-95-5, 220127-57-1) irinotecan (100286-90-6) itraconazole (84625-61-6) lapatinib (231277-92-2, 388082-78-8, 437755-78-7) lomustine (13010-47-4) navelbine (71486-22-1) oxaliplatin (61825-94-3) paclitaxel (33069-62-4) pemetrexed (137281-23-3, 150399-23-8) phenobarbital (50-06-6, 57-30-7, 8028-68-0) phenytoin (57-41-0, 630-93-3) topotecan (119413-54-6, 123948-87-8) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2012290964 MEDLINE PMID 22445506 (http://www.ncbi.nlm.nih.gov/pubmed/22445506) PUI L364843402 DOI 10.1016/S1130-6343(11)70019-8 FULL TEXT LINK http://dx.doi.org/10.1016/S1130-6343(11)70019-8 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 343 TITLE The call for a more formalised “Buddy” system; an audit of the breast cancer onoplastic service at frenchay hospital AUTHOR NAMES Laurence N. McIntosh J. Barker J. Cawthorn S. Sahu A. AUTHOR ADDRESSES (Laurence N.; McIntosh J.; Barker J.; Cawthorn S.; Sahu A.) Frenchay Hospital, Bristol, Frenchay Park Road, Frenchay, Bristol, BS16 1LE, United Kingdom. CORRESPONDENCE ADDRESS N. Laurence, Frenchay Hospital, Bristol, Frenchay Park Road, Frenchay, Bristol, BS16 1LE, United Kingdom. SOURCE European Journal of Surgical Oncology (2011) 37:5 (S14). Date of Publication: May 2011 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2011 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2011-05-16 to 2011-05-17 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: A guide to good practice for oncoplastic breast surgery was published in EJSO in 2007. Guidance was given to ensure that each patient has adequate time to make an informed decision; is supported by a specialist nurse; views a range of educational materials and discusses perceived risks and benefits. Although no evidence was referenced, women should have an opportunity to meet other patients, 'buddy'. Methods: To ensure these standards are met, 60 written questionnaires were sent to breast reconstruction patients. Results: 37 questionnaires were returned. 86% of patients had enough time to make an informed decision, 76% were aware of the complications, 95% were glad they had had a reconstruction while 70% were happy with their new breast. Although 70% thought they had had the correct reconstructive option, 30% were either uncertain or wished they had an alternative procedure. Patients used a variety of information tools. Most relied on their surgeon, specialist nurse and information sheets. 19% had access to a 'buddy' but 70% would have used this option if it had been available, 81% would be willing to speak to other patients about their experiences. Conclusion: Patients who require a breast reconstruction at Frenchay are given good access to information and time to consider their reconstructive options. However, we need to improve our discussion about alternative operations and access to a 'buddy' more easily available. With many patients keen to give support/information, units offering a reconstruction service should be aware of ease of access to 'buddy patients'. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast surgery clinical audit hospital EMTREE MEDICAL INDEX TERMS access to information breast breast reconstruction female medical specialist nurse patient questionnaire risk surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70394337 DOI 10.1016/j.ejso.2011.03.052 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.03.052 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 344 TITLE Pre-operative assessment of the axilla in breast cancer using ultrasound: A review of practice in a District General Hospital AUTHOR NAMES McWhirter D. Lund J. Razzaq F. AUTHOR ADDRESSES (McWhirter D.; Lund J.; Razzaq F.) Warrington General Hospital, Lovely Lane, Warrington, WA5 1QG, United Kingdom. CORRESPONDENCE ADDRESS D. McWhirter, Warrington General Hospital, Lovely Lane, Warrington, WA5 1QG, United Kingdom. SOURCE European Journal of Surgical Oncology (2011) 37:5 (S8). Date of Publication: May 2011 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2011 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2011-05-16 to 2011-05-17 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Surgery for breast cancer involves resection of the tumour with axillary lymph node dissection (ALND) in the form of axillary node clearance (ANC), sampling (ANS) or sentinel node biopsy (SNB). Due to the morbidity of clearance, less invasive techniques have become common. Axillary ultrasound (USS) to identify malignant nodes is used pre-operatively to aid decision making regarding what axillary surgery to perform. We reviewed our practice to validate the use of USS in clinical practice. Methods: We identified symptomatic breast cancer patients from the MDT database from January 2007 to August 2010. Radiology and Histo-pathology databases were used to collect results of the USS and axillary node histology. Results: 101 patients were identified. The sensitivity and specificity of USS was 56% and 99% respectively. The positive predictive value (PPV) and negative predictive value (NPV) was 94% and 86% respectively. The overall accuracy was 87%. Discussion: The low sensitivity means that USS cannot replace axillary surgery to assess tumour stage. The high PPV means it is excellent at confirming disease. These patients can proceed straight to ANC and avoid two procedures. The high specificity and NPV mean that USS is useful as a screening test. It will correctly identify most patients who do not have axillary disease and can have either ANS or SNB in the first instance. Our rates are favourably comparable to the published literature. Conclusion: We believe that axillary USS is an important part in the assessment and treatment of breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axilla breast cancer breast surgery general hospital ultrasound EMTREE MEDICAL INDEX TERMS axillary lymph node biopsy cancer patient clinical practice data base decision making histology lymph node dissection morbidity neoplasm pathology patient predictive value radiology sampling screening test sensitivity and specificity surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70394316 DOI 10.1016/j.ejso.2011.03.031 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.03.031 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 345 TITLE How does a German audience appraise an American decision aid on early stage breast cancer? AUTHOR NAMES Albrecht K. Simon D. Buchholz A. Reuter K. Frosch D. Seebauer L. Härter M. AUTHOR ADDRESSES (Albrecht K., karoline.albrecht@uniklinik-freiburg.de; Simon D.; Buchholz A.; Reuter K.; Seebauer L.; Härter M.) University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Epidemiology and Health Services Research, Germany. (Härter M.) University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Institute and Policlinic for Medical Psychology, Germany. (Frosch D.) Department of Health Services Research, Palo Alto Medical Foundation Research Institute, United States. (Frosch D.) Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, United States. CORRESPONDENCE ADDRESS K. Albrecht, University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Epidemiology and Health Services Research, Hauptstrasse 5, D-79104 Freiburg, Germany. Email: karoline.albrecht@uniklinik-freiburg.de SOURCE Patient Education and Counseling (2011) 83:1 (58-63). Date of Publication: April 2011 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To investigate how a German audience appraises an American video-based decision aid on early stage breast cancer for potential use in Germany. Methods: A German synchronized voice-over version was produced and subject to different focus groups with patients (n= 9), health care providers (n= 7) and German health care experts (n= 15) using an individual questionnaire-based evaluation and a moderated group discussion. Research questions included a general appraisal of the decision aid and the exploration of adaptation needs for use in Germany. Descriptive statistics were calculated and the qualitative data were analyzed applying an inductive approach to categorize the statements. Results: The general appraisal of the decision aid revealed positive results in all groups, especially with regard to comprehensible presentation of information and integration of patients' testimonials. However, cultural differences between the American decision aid and Germany were debated in all groups. Conclusion: Despite a high general interest and positive appraisal of the decision aid, the results of this study suggest that it cannot just be translated and used in another country. Practice implications: The decision aid needs further cultural adaptation and testing in an implementation study before it can be transferred to Germany. © 2010 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system medical decision making shared decision making EMTREE MEDICAL INDEX TERMS adult article cancer patient controlled study cultural factor female Germany health care personnel human medical expert medical information patient decision making patient participation priority journal United States videorecording EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011115712 MEDLINE PMID 20627441 (http://www.ncbi.nlm.nih.gov/pubmed/20627441) PUI L50938419 DOI 10.1016/j.pec.2010.04.038 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2010.04.038 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 346 TITLE Preserving the self: the process of decision making about hereditary breast cancer and ovarian cancer risk reduction. AUTHOR NAMES Howard A.F. Balneaves L.G. Bottorff J.L. Rodney P. AUTHOR ADDRESSES (Howard A.F.) School of Population and Public Health, University of British Columbia, Vancouver, Canada. (Balneaves L.G.; Bottorff J.L.; Rodney P.) CORRESPONDENCE ADDRESS A.F. Howard, School of Population and Public Health, University of British Columbia, Vancouver, Canada. Email: fuchsiahoward@mac.com SOURCE Qualitative health research (2011) 21:4 (502-519). Date of Publication: Apr 2011 ISSN 1049-7323 ABSTRACT Women who carry BRCA1 or BRCA2 (BRCA1/2) gene mutations have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e., mastectomy and salpingo-oophorectomy). We conducted a grounded theory study with 22 BRCA1/2 mutation-carrier women to understand how women make decisions about these risk-reducing strategies. Preserving the self was the overarching decision-making process evident in the participants' descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women's perceived proximity to cancer. The women engaged in five decision-making styles, and these were characterized by the use of specific decision-making approaches. These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (epidemiology, surgery) decision making hereditary tumor (epidemiology) ovary tumor (epidemiology, surgery) tumor suppressor gene EMTREE MEDICAL INDEX TERMS adult aged article early diagnosis female genetic screening genetics human mastectomy methodology middle aged mutation ovariectomy psychologic test psychological aspect qualitative research risk reduction women's health LANGUAGE OF ARTICLE English MEDLINE PMID 20980697 (http://www.ncbi.nlm.nih.gov/pubmed/20980697) PUI L362247883 DOI 10.1177/1049732310387798 FULL TEXT LINK http://dx.doi.org/10.1177/1049732310387798 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 347 TITLE Uptake of preventive options amongst women at high risk of breast cancer: What can we do to improve uptake to prevention trials? AUTHOR NAMES Evans G.D. Harvie M. Bundred N. Howell A. AUTHOR ADDRESSES (Evans G.D.; Harvie M.; Bundred N.; Howell A.) Genesis Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. (Evans G.D.) University of Manchester, Manchester Academic Health Science Centre, St. Mary's Hospital, United Kingdom. (Howell A.) Manchester Breast Centre, University of Manchester, Christie NHS Trust, Withington, Manchester, United Kingdom. CORRESPONDENCE ADDRESS G.D. Evans, Genesis Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, United Kingdom. SOURCE Familial Cancer (2011) 10 SUPPL. 2 (S79). Date of Publication: April 2011 CONFERENCE NAME 12th International Meeting on Psychosocial Aspects of Hereditary Cancer, IMPAHC CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2011-04-27 to 2011-04-29 ISSN 1389-9600 BOOK PUBLISHER Springer Netherlands ABSTRACT Introduction: Uptake of cancer trials and in particular prevention trials has been disappointing globally. In contrast in Northern Europe there are high levels of uptake for risk reducing Mastectomy (RRM). Methods: We have assessed uptake to three randomized chemotherapy breast cancer prevention trials and two dietary prevention trials in women at increased familial risk and compared it with uptake of screening trials and RRM across a range of risk categories. Results: Uptake of drug prevention trials remains lowat 5.3-13.6%, but is significantly higher in the high (12%) compared to very high risk group (8.4%) for IBIS1 and IBIS2 combined (p = 0.004). Recruitment to two dietary prevention studies via mailshot was also disappointingly low at 6.2% and 12.5%. In contrast uptake to two mammography screening trials was[90% in all risk categories. Uptake of RRM was 50% after 7 years amongst unaffected BRCA1/2 carriers with 138/373 female carriers having undergone RRM. Uptake of RRM was significantly related to lifetime risk and age but continued over several years. Inwomen not knownto carry a BRCA mutation 6.4% of women at 40-45% lifetime risk, 2.5% of women at 33-39% risk and 1.8% of women at 25-32% lifetime risk underwent BRRM (p\0.005). BRRSPO uptake was greater in BRCA1 (52%) than BRCA2 (28%) carriers but in both groups tended to occur within the first two years after gene test (except in the youngest age group) and in women between the ages of 35 and 45. Conclusions: More work must be done to improve recruitment to prevention trials if they are to be seen as viable alternatives to risk reducing surgery. Impact: Trial designs and decision aids need to be developed to improve recruitment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female hereditary tumor human prevention study risk social psychology EMTREE MEDICAL INDEX TERMS cancer prevention chemotherapy Europe gene groups by age high risk population lifespan mammography mastectomy mutation neoplasm screening study design surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70474133 DOI 10.1007/s10689-011-9430-5 FULL TEXT LINK http://dx.doi.org/10.1007/s10689-011-9430-5 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 348 TITLE Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations. AUTHOR NAMES Brown R.F. Butow P.N. Juraskova I. Ribi K. Gerber D. Bernhard J. Tattersall M.H. AUTHOR ADDRESSES (Brown R.F.) Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. (Butow P.N.; Juraskova I.; Ribi K.; Gerber D.; Bernhard J.; Tattersall M.H.) CORRESPONDENCE ADDRESS R.F. Brown, Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. SOURCE Health expectations : an international journal of public participation in health care and health policy (2011) 14:1 (29-37). Date of Publication: Mar 2011 ISSN 1369-7625 (electronic) ABSTRACT Shared Decision Making (SDM) is widely accepted as the preferred method for reaching treatment decisions in the oncology setting including those about clinical trial participation: however, there is some disagreement between researchers over the components of SDM. Specific standardized coding systems are needed to help overcome this difficulty. The first objective was to describe the development of an oncology specific SDM coding system, the DAS-O. The second objective was to provide reliability and validity data supporting the DAS-O. Consultation data were available from tertiary cancer center out patient oncology clinics in: Australia, New Zealand (ANZ), Switzerland, Germany and Austria (SGA). Patients were women with a confirmed diagnosis of early stage breast cancer. Reliability data were from 18 randomly selected coded transcripts drawn from ANZ and SGA. Concurrent validity data are from 55 (ANZ) consultations. Inter and Intra rater reliability data was evaluated using Kappa correlation statistics and correlation coefficients. Correlation coefficients were used to assess concurrent validity between the DAS-O and two other SDM coding systems, OPTION and DSAT. Inter and Intra rater reliability for the system were high with average Kappas of 0.58 and 0.65 respectively. Correlation coefficients between DAS-O and OPTION was 0.73 and >0.5 for DSAT. We have developed a reliable and valid coding system for identifying and rating the quality of SDM in breast cancer consultations. © 2010 The Authors. Health Expectations © 2010 Blackwell Publishing Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) decision making patient participation EMTREE MEDICAL INDEX TERMS article doctor patient relation female human interpersonal communication methodology observer variation reproducibility LANGUAGE OF ARTICLE English MEDLINE PMID 20629766 (http://www.ncbi.nlm.nih.gov/pubmed/20629766) PUI L361917465 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 349 TITLE Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions? AUTHOR NAMES Sivell S. Edwards A. Elwyn G. Manstead A.S. AUTHOR ADDRESSES (Sivell S.) Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK. (Edwards A.; Elwyn G.; Manstead A.S.) CORRESPONDENCE ADDRESS S. Sivell, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK. Email: sivells2@cardiff.ac.uk SOURCE Health expectations : an international journal of public participation in health care and health policy (2011) 14 Suppl 1 (6-19). Date of Publication: Mar 2011 ISSN 1369-7625 (electronic) ABSTRACT To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. Literature search and narrative synthesis of data. Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices. © 2010 Blackwell Publishing Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system patient participation EMTREE MEDICAL INDEX TERMS article body image female human methodology patient education patient preference psychological aspect risk assessment treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 20579123 (http://www.ncbi.nlm.nih.gov/pubmed/20579123) PUI L560012239 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 350 TITLE What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative. AUTHOR NAMES Feibelmann S. Yang T.S. Uzogara E.E. Sepucha K. AUTHOR ADDRESSES (Feibelmann S.) Health Decision Research Unit, Massachusetts General Hospital (MGH), Boston, MA 02114, USA. (Yang T.S.; Uzogara E.E.; Sepucha K.) CORRESPONDENCE ADDRESS S. Feibelmann, Health Decision Research Unit, Massachusetts General Hospital (MGH), Boston, MA 02114, USA. SOURCE Health expectations : an international journal of public participation in health care and health policy (2011) 14 Suppl 1 (85-95). Date of Publication: Mar 2011 ISSN 1369-7625 (electronic) ABSTRACT The Breast Cancer Initiative (BCI) was started in 2002 to disseminate breast cancer decision aids (PtDAs) to providers. We analysed BCI programme data for 195 sites and determined the proportion of sites involved in each of five stages of dissemination and implementation of PtDAs. We conducted cross-sectional mail and telephone surveys of 79 sites with the most interest in implementation. We examined barriers associated with sustained use of the PtDAs. Since 2002 we attempted contact with 195 sites to join the BCI. The majority indicated interest in using PtDAs 172 of 195 (88%), 93 of 195 signed up for the BCI (48%), 57 of 195 reported distributing PtDAs to at least one patient (57%), and 46 of 195 reported sustained use (24%). We analysed data from interviews with 59 of 79 active sites (75% response rate). The majority of providers 49 of 59 (83%) had watched the PtDAs, and 46 of 59 (78%) distributed them to patients. The most common barriers were lack of a reliable way to identify patients before decisions are made (37%), a lack of time to distribute the PtDAs (22%) and having too many educational materials (15%). Sites that indicated a lack of clinician support as a barrier were significantly less likely to have sustained use compared to sites that didn't (33% vs. 74%, P = 0.02). Community breast cancer providers, both physicians and non-physicians, express a high interest in using PtDAs with their patients. About a quarter of sites report sustained use of the PtDAs in routine care. © 2011 Blackwell Publishing Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) decision support system information dissemination patient education EMTREE MEDICAL INDEX TERMS article female human methodology LANGUAGE OF ARTICLE English MEDLINE PMID 21323821 (http://www.ncbi.nlm.nih.gov/pubmed/21323821) PUI L560012246 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 351 TITLE Decisional factors influencing breast reconstruction post-mastectomy: Results from a national survey AUTHOR NAMES Amsellem M. Ahmed I. Haskins N. Weiss E. Gubin A. Champion L. Buzaglo J. AUTHOR ADDRESSES (Amsellem M.; Ahmed I.; Haskins N.; Weiss E.; Gubin A.; Champion L.; Buzaglo J.) Cancer Support Community, Washington, United States. CORRESPONDENCE ADDRESS M. Amsellem, Cancer Support Community, Washington, United States. SOURCE Psycho-Oncology (2011) 20:1 SUPPL. 1 (105). Date of Publication: February 2011 CONFERENCE NAME 8th Annual Conference of the American Psychosocial Oncology Society CONFERENCE LOCATION Anaheim, CA, United States CONFERENCE DATE 2011-02-17 to 2011-02-19 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT PURPOSE: The decision whether to undergo breast reconstruction can be complex for women diagnosed with breast cancer. Guided by Cognitive-Social theory, the Cancer Support Community (CSC) conducted a national survey in an effort to better understand the patient decision- making process around breast reconstruction. METHODS: 840 U.S. women with breast cancer (762 eligible for breast reconstruction) participated in the survey online or by paper-and-pencil at Cancer Support Community affiliate sites in 2010. In addition to demographics, information about their diagnosis, treatment, and experience with reconstruction, women rated the influence of various psychosocial factors on their decision about whether or not to undergo reconstruction. RESULTS: The majority of participants (63.2%) have chosen to undergo reconstruction and many participants currently undergoing treatment, plan to consider it at a later time. 18.5% of participants have already decided against undergoing reconstruction. Participants who chose to have reconstruction generally reported that body image (70.3%) and physical appearance (73.1%) influenced their decision “a great deal”, whereas factors that were “not at all” influential included financial concerns (69%) and opinions of others (60.3%). Participants who chose not to undergo reconstruction reported concerns about side effects (62.1%) , concerns about undergoing additional procedures (59.3%), and fear of recurrence (42.1%) as influencing their decision “a great deal”, but sexuality (39%) and body image (33%) did not influence their decision. For those currently considering reconstruction, physical appearance and concerns about side effects influenced participants (60.7% and 52.7%, respectively) “a great deal”. These individuals also had the largest percentage of respondents endorsing experiences of other women with breast cancer (66.1%) as “somewhat” influential in their decision. All differences between groups were statistically significant. CONCLUSIONS: Multiple psychosocial factors influence the decision whether or not to undergo breast reconstruction. RESEARCH IMPLICATIONS: These results suggest the relative weight of psychosocial decisional factors in this often challenging and personal decision- making process. CLINICAL IMPLICATIONS: Results will inform the development of a new national educational program, entitled Frankly Speaking About Cancer: Spotlight on Breast Reconstruction which, among other goals, provides tools necessary to empower patients and support effective decision-making tailored to the individual. FUNDING: Developed with support from Mentor Worldwide LLC, a leading supplier of aesthetic medical products. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy oncology society EMTREE MEDICAL INDEX TERMS body image breast cancer community decision making diagnosis fear female neoplasm patient patient decision making sexuality side effect social psychology speech teacher United States weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70365473 DOI 10.1111/j.1755-148X.2011.01915.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1755-148X.2011.01915.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 352 TITLE Are patients making high-quality decisions about breast reconstruction after mastectomy? [outcomes article]. AUTHOR NAMES Lee C.N. Belkora J. Chang Y. Moy B. Partridge A. Sepucha K. AUTHOR ADDRESSES (Lee C.N.) Division of Plastic and Reconstructive Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7195, USA. (Belkora J.; Chang Y.; Moy B.; Partridge A.; Sepucha K.) CORRESPONDENCE ADDRESS C.N. Lee, Division of Plastic and Reconstructive Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7195, USA. Email: cnlee@med.unc.edu SOURCE Plastic and reconstructive surgery (2011) 127:1 (18-26). Date of Publication: Jan 2011 ISSN 1529-4242 (electronic) ABSTRACT Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. The authors sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction. A cross-sectional survey of early-stage breast cancer survivors from four university medical centers was conducted. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. A multivariable linear regression model of characteristics associated with knowledge and a logistic regression model of factors associated with having reconstruction were developed. A total of 84 patients participated (59 percent response rate). Participants answered 37.9 percent of knowledge questions correctly. Higher education (beta, 15 percent; p = 0.003) and having reconstruction (beta, 21 percent; p < 0.0001) were associated with higher knowledge. The goals "use your own tissue to make a breast" (odds ratio, 1.53; 95 percent CI, 1.15, 2.05) and "wake up after mastectomy with reconstruction underway" (odds ratio, 1.66; 95 percent CI, 1.30, 2.12) were associated with reconstruction. The goal "avoid putting foreign material in your body" was associated with no reconstruction (odds ratio, 0.64; 95 percent CI, 0.48, 0.86). Most patients reported they mainly made the decision or made the decision with the doctor equally (93 percent; 95 percent CI, 85 to 97 percent) and that their degree of involvement was about right (85 percent; 95 percent CI, 75 to 91 percent). Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients' goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision making mastectomy patient EMTREE MEDICAL INDEX TERMS article attitude to health breast tumor (surgery) cross-sectional study female human methodology middle aged motivation psychological aspect statistical model LANGUAGE OF ARTICLE English MEDLINE PMID 21200195 (http://www.ncbi.nlm.nih.gov/pubmed/21200195) PUI L361357305 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 353 TITLE Surgical Considerations in Early-Stage Breast Cancer: Lessons Learned and Future Directions AUTHOR NAMES Sabel M.S. AUTHOR ADDRESSES (Sabel M.S., msabel@umich.edu) University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. CORRESPONDENCE ADDRESS M.S. Sabel, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States. Email: msabel@umich.edu SOURCE Seminars in Radiation Oncology (2011) 21:1 (10-19). Date of Publication: January 2011 ISSN 1053-4296 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Emerging evidence regarding the relationship between local failure and outcome in breast cancer has placed increased emphasis on the surgeon's role in reducing local recurrence after breast-conserving surgery. This includes both improving patient selection and optimizing the procedure. Proper patient selection, selective use of magnetic resonance imaging, and better patient-physician communication including the use of decision aids can optimize both local control and patient satisfaction without unnecessarily increasing the mastectomy rate. Neoadjuvant systemic therapy can increase both the number of patients eligible for breast-conservation surgery as well as the likelihood of success. Adequate surgical margins are crucial and can be achieved without excessive re-excision rates with detailed preoperative planning, consideration of oncoplastic resections. and intraoperative margin analysis. This article reviews several areas in which the surgeon can help ensure the success of breast-conservation therapy. © 2011 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy breast biopsy breast calcification breast reconstruction cancer chemotherapy cancer localization cancer recurrence cancer survival clinical trial gene mutation human lupus vulgaris mastectomy medical decision making nuclear magnetic resonance imaging partial mastectomy patient selection pregnancy preoperative evaluation priority journal reoperation review scleroderma surgical approach tissue section treatment contraindication treatment outcome tumor volume ultrasound EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010672636 MEDLINE PMID 21134649 (http://www.ncbi.nlm.nih.gov/pubmed/21134649) PUI L360114223 DOI 10.1016/j.semradonc.2010.08.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.semradonc.2010.08.002 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 354 TITLE Knowledge of genomic testing among early-stage breast cancer patients AUTHOR NAMES Richman A.R. Tzeng J.P. Carey L.A. Retèl V.P. Brewer N.T. AUTHOR ADDRESSES (Richman A.R.; Tzeng J.P.; Brewer N.T., ntb1@unc.edu) University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, United States. (Carey L.A.) University of North Carolina, School of Medicine, Chapel Hill, NC, United States. (Carey L.A.; Brewer N.T., ntb1@unc.edu) University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States. (Retèl V.P.) Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS A. R. Richman, Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States. SOURCE Psycho-Oncology (2011) 20:1 (28-35). Date of Publication: January 2011 ISSN 1057-9249 1099-1611 (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Background: Genomic recurrence risk test results now inform clinical decisions about adjuvant treatment for women with early-stage breast cancer. We sought to understand patients' knowledge of these tests and correlates of their knowledge. Methods: Participants in this cross-sectional study were 78 women, treated for early-stage, estrogen receptor-positive breast cancer with 0-3 positive lymph nodes, whose medical records indicated they received Oncotype DX testing earlier. We mailed a questionnaire that assessed knowledge of genomic recurrence risk testing (13 item scale, alpha=0.83) and reviewed medical charts of consenting patients. Results: Knowledge about genomic recurrence risk testing was low (mean knowledge score=67%, SD=0.23). Low knowledge scores were more commonly due to responses of 'don't know' than incorrect answers. Most women (91%) clearly understood that test results can aid decisions about chemotherapy, and few (22%) understood that the test's estimate of the chance of metastasis assumes the patient is receiving hormone therapy. Higher knowledge about genomic recurrence risk testing was associated with higher education, reading ability, and numeracy. Knowledge was higher among women who recalled receiving both verbal and printed information about the test and among women who had active roles in deciding about their treatments. Higher knowledge was also associated with having fewer concerns about genomic testing. Discussion: Among early-stage breast cancer patients who received Oncotype DX, we found low knowledge about many aspects of genomic recurrence risk testing. Research is needed to understand testing information provided to patients and best practices for patient education. Copyright © 2010 John Wiley & Sons, Ltd. EMTREE DRUG INDEX TERMS estrogen receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, radiotherapy, surgery) early cancer (diagnosis) genetic screening knowledge EMTREE MEDICAL INDEX TERMS adult article cancer chemotherapy cancer hormone therapy cancer patient cancer radiotherapy cancer recurrence cancer research cancer risk cancer staging comorbidity cross-sectional study educational status family history female genome analysis human lymph node major clinical study mastectomy medical record review menopause metastasis patient decision making patient education questionnaire rating scale reading retrospective study scoring system EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011000528 MEDLINE PMID 20200857 (http://www.ncbi.nlm.nih.gov/pubmed/20200857) PUI L361005015 DOI 10.1002/pon.1699 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1699 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 355 TITLE Review of third and fourth re-excision for narrow or positive margins of invasive and intraductal carcinoma. AUTHOR NAMES Subhas G. Shah A.J. Gupta A. Cook J. Dubay L. Silapaswan S. Kolachalam R. Kestenberg W. Ferguson L. Jacobs M.J. Goriel Y. Mittal V.K. AUTHOR ADDRESSES (Subhas G.) Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan 48075, USA. (Shah A.J.; Gupta A.; Cook J.; Dubay L.; Silapaswan S.; Kolachalam R.; Kestenberg W.; Ferguson L.; Jacobs M.J.; Goriel Y.; Mittal V.K.) CORRESPONDENCE ADDRESS G. Subhas, Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan 48075, USA. SOURCE International surgery (2011) 96:1 (18-20). Date of Publication: 2011 Jan-Mar ISSN 0020-8868 ABSTRACT The trend in breast surgery has shifted toward breast conservation. We reviewed our third and fourth breast re-excision cases, with an analysis of various factors used in making this decision. A retrospective analysis identified 585 patients who underwent re-excision surgery for positive or close margins of invasive carcinoma or ductal carcinoma in situ (DCIS). Of these patients 75 (13%) and 17 (3%) underwent third and fourth re-excisions, respectively. The indication for a third re-excision was the presence of positive and/or close (< or = 1 mm) margins for invasive carcinoma or DCIS in 72/75 patients. A third re-excision was done 31 days (range 8-123 days) after the second re-excision. Re-excision of margins was done in 45 (60%) patients, whereas 30 (40%) patients underwent mastectomy. Residual tumor mandated a fourth re-excision in 17 patients, which was done 45 days (range 14-87 days) after the third surgery. Re-excision of margins was done in 6 patients, whereas 11 patients underwent mastectomy. Involved or close margins with DCIS were the most common indication for re-excision, accounting for 61/75 (82%) of third and 16/17 (94%) of fourth re-excisions. Histopathology revealed that 28/75 (37%) of third and 7/17 (41%) of fourth re-excision patients had no residual tumor. In conclusion, the majority of re-excisions was done for margins < 1 mm. Lower rates of re-excision were noted in well-differentiated invasive carcinomas. A close or involved DCIS margin was more likely to lead to a third and even a fourth re-excision. The absence of residual tumors in 40% of patients undergoing third and fourth re-excisions calls for a review of margin guidelines for breast re-excision. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) carcinoma in situ (surgery) minimal residual disease (surgery) Paget nipple disease (surgery) reoperation EMTREE MEDICAL INDEX TERMS adult aged article female human mastectomy middle aged pathology retrospective study statistics tumor invasion LANGUAGE OF ARTICLE English MEDLINE PMID 21675615 (http://www.ncbi.nlm.nih.gov/pubmed/21675615) PUI L362241288 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 356 TITLE Assessing the impact of user-centered research on a clinical trial eHealth tool via counterbalanced research design AUTHOR NAMES Atkinson N.L. Massett H.A. Mylks C. McCormack L.A. Kish-Doto J. Hesse B.W. Wang M.Q. AUTHOR ADDRESSES (Atkinson N.L., atkinson@umd.edu; Wang M.Q.) Department of Public and Community Health, University of Maryland, College Park, MD, United States. (Massett H.A.) Office of Market Research and Evaluation, National Cancer Institute, NIH, Rockville, MD, United States. (Mylks C.) IDox Solutions, Bethesda, MD, United States. (McCormack L.A.) RTI International, Research Triangle Park, NC, United States. (Kish-Doto J.) RTI International, Rockville, MD, United States. (Hesse B.W.) Health Communications and Informatics Research Branch, US National Cancer Institute, NIH, Rockville, MD, United States. CORRESPONDENCE ADDRESS N.L. Atkinson, Department of Public and Community Health, University of Maryland, Suite 2387 Valley Drive, College Park, MD 20742, United States. Email: atkinson@umd.edu SOURCE Journal of the American Medical Informatics Association (2011) 18:1 (24-31). Date of Publication: January 2011 ISSN 1067-5027 1527-974X (electronic) BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Objective: Informatics applications have the potential to improve participation in clinical trials, but their design must be based on user-centered research. This research used a fully counterbalanced experimental design to investigate the effect of changes made to the original version of a website, http://BreastCancerTrials.org/, and confirm that the revised version addressed and reinforced patients' needs and expectations. Design: Participants included women who had received a breast cancer diagnosis within the last 5 years (N=77). They were randomized into two groups: one group used and reviewed the original version first followed by the redesigned version, and the other group used and reviewed them in reverse order. Measurements: The study used both quantitative and qualitative measures. During use, participants' click paths and general reactions were observed. After use, participants were asked to answer survey items and open-ended questions to indicate their reactions and which version they preferred and met their needs and expectations better. Results: Overall, the revised version of the site was preferred and perceived to be clearer, easier to navigate, more trustworthy and credible, and more private and safe overall. However, users who viewed the original version last had similar attitudes toward both versions. Conclusion: By applying research findings to the redesign of a website for clinical trial searching, it was possible to re-engineer the interface to better support patients' decisions to participate in clinical trials. The mechanisms of action in this case appeared to revolve around creating an environment that supported a sense of personal control and decisional autonomy. © 2010 by the American Medical Informatics Association. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electronic medical record EMTREE MEDICAL INDEX TERMS adult article breast cancer cancer diagnosis clinical research controlled study decision making evaluation study experimental design female health survey human Internet major clinical study medical research qualitative analysis quantitative analysis randomized controlled trial (topic) rating scale EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010706809 MEDLINE PMID 21169619 (http://www.ncbi.nlm.nih.gov/pubmed/21169619) PUI L360216826 DOI 10.1136/jamia.2010.006122 FULL TEXT LINK http://dx.doi.org/10.1136/jamia.2010.006122 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 357 TITLE Importance of decision quality in breast cancer care AUTHOR NAMES Sepucha K.R. Belkora J. AUTHOR ADDRESSES (Sepucha K.R., ksepucha@partners.org) Health Decision Sciences Center, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, United States. (Belkora J.) Institute for Health Policy Studies, University of California, San Francisco, CA, United States. CORRESPONDENCE ADDRESS K. R. Sepucha, Health Decision Sciences Center, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, United States. Email: ksepucha@partners.org SOURCE Psicooncologia (2010) 7:2-3 (313-328). Date of Publication: 2010 ISSN 1696-7240 1988-8287 (electronic) BOOK PUBLISHER Asociacion de Psicooncologia de Madrid, Buzon 24, Madrid, Spain. ABSTRACT Background: In breast cancer, treatment decisions are challenging as patients, their families and providers need to sort through an ever expanding array of options for surgery, radiation, reconstruction and systemic therapy. Objective: To describe efficacy and effectiveness of interventions designed to improve decision quality in breast cancer care. Methods: We describe the competencies required of providers and patients to engage in shared decision making, and then present interventions and metrics that have been shown to improve the quality of medical treatment decisions. A case study illustrates how decision support tools have been implemented in a cancer center in the United States. Results: Patients and providers face multiple decisions after a breast cancer diagnosis and too often these decisions are made without patients having adequate information or involvement. Decision aids, prompt sheets and consultation recordings have been shown to improve the quality of decisions by increasing knowledge, reducing decision conflict and improving communication. These tools have been successfully integrated in a variety of cancer centers, but require some resources and infrastructure to make it work. Conclusions: Patients, their families and providers need to work together to select cancer treatments. These interactions are complex and can be improved through the implementation of decision support. EMTREE DRUG INDEX TERMS antineoplastic agent (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy, surgery) decision support system medical decision making self concept EMTREE MEDICAL INDEX TERMS adverse outcome article audio recording body image breast reconstruction cancer center cancer chemotherapy cancer patient cancer radiotherapy cancer surgery cancer survivor clinical effectiveness clinical evaluation early menopause (side effect) evidence based practice human interpersonal communication partial mastectomy patient preference patient referral patient satisfaction quality of life treatment outcome treatment planning United States EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2011412903 PUI L362220810 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 358 TITLE Implementing shared treatment decision making and treatment decision aids: A cautionary tale AUTHOR NAMES Charles C. Gafni A. Freeman E. AUTHOR ADDRESSES (Charles C., charlesc@mcmaster.ca; Gafni A.) Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8N, 3Z5, Canada. (Charles C., charlesc@mcmaster.ca; Gafni A.) Centre for Health Economics and Policy Analysis, McMaster University, Canada. (Freeman E.) Edith Kirchmann Postdoctoral research Fellow in Psychosocial Oncology and Palliative Care, University Health, Department of Psychiatry, Network University of Toronto, Canada. CORRESPONDENCE ADDRESS C. Charles, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8N, 3Z5, Canada. Email: charlesc@mcmaster.ca SOURCE Psicooncologia (2010) 7:2-3 (243-255). Date of Publication: 2010 ISSN 1696-7240 1988-8287 (electronic) BOOK PUBLISHER Asociacion de Psicooncologia de Madrid, Buzon 24, Madrid, Spain. ABSTRACT Clinical and research interest in shared treatment decision making (STDM) and decision aids (DA) evolved in the 1980's and 1990's with an initial focus on patients with cancer, and particularly, women with breast cancer. This interest has undergone a shift in emphasis over time from curiosity about the meaning of these concepts and their potential to improve patient participation in treatment decision making to wide scale endorsement, attempts to expand implementation in a variety of clinical settings, measurement of multiple outcomes at the clinical and public policy level, and the development of standardized criteria for evaluating DA. In this chapter we raise the question: are we moving too fast to promote implementation of STDM and DA before resolving important challenges that still exist about the meaning and merits of these initiatives? We discuss four such challenges: i) ambiguity and inconsistency in the defi nition of STDM, ii) variations in patient and physician preferences for STDM, iii) the increase in the number and range of goals defi ned for STDM and /or DA to achieve, and iv) the lack of well documented theoretical and empirical support for criteria to be used in evaluating DA quality, and potentially for purposes of DA certifi cation. These fi ndings suggest the need for caution, for more thoughtful analysis, and additional research on the challenges raised above prior to wide scale endorsement of STDM and DA in routine clinical practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system medical decision making shared treatment decision making EMTREE MEDICAL INDEX TERMS article certification clinical evaluation clinical practice cultural anthropology doctor patient relation empirical research evidence based medicine family female health care personnel health care policy health care quality health practitioner human law medical research outcome assessment patient participation patient preference physician attitude quality control treatment planning EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2011412899 PUI L362220806 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 359 TITLE Decision making in breast cancer prevention AUTHOR NAMES Ozanne E. Esserman L. AUTHOR ADDRESSES (Ozanne E., elissa@mgh-ita.org) Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St., 10th Floor, Boston, MA 02114, United States. (Esserman L.) Department of Surgery and Radiology, Carol Franc Buck Breast Cancer Center, University of California San Francisco, United States. CORRESPONDENCE ADDRESS E. Ozanne, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St., 10th Floor, Boston, MA 02114, United States. Email: elissa@mgh-ita.org SOURCE Psicooncologia (2010) 7:2-3 (299-311). Date of Publication: 2010 ISSN 1696-7240 1988-8287 (electronic) BOOK PUBLISHER Asociacion de Psicooncologia de Madrid, Buzon 24, Madrid, Spain. ABSTRACT Breast cancer is one of the most common cancers among women and the leading cause of death in women between the ages of 45-60 in most developed countries. The effi cacy of prevention options has been established and includes lifestyle modifi cations, chemoprevention, and prophylactic surgery. Despite the effi - cacy of these options, breast cancer prevention remains underused, resulting in avoidable morbidity and mortality. Here, the main barriers to effective use of breast cancer prevention are outlined and a framework to facilitate patientcentered and evidence-based breast cancer prevention decision making is presented. The framework is intended to encourage a shared decision making approach to prevention decisions, within the context of a woman's overall health. The inclusion of effective lifestyle interventions makes this framework relevant to most women, and is not exclusive to women at increased risk of developing breast cancer. EMTREE DRUG INDEX TERMS estrogen (adverse drug reaction, drug combination, drug therapy) estrogen plus progestin (adverse drug reaction, drug therapy) gestagen (adverse drug reaction, drug combination, drug therapy) raloxifene (adverse drug reaction, drug therapy) tamoxifen (adverse drug reaction, drug therapy) tibolone (adverse drug reaction, drug therapy) unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, side effect, drug therapy, prevention, side effect) cancer prevention medical decision making EMTREE MEDICAL INDEX TERMS adverse outcome alcohol consumption article body mass cancer chemotherapy cancer mortality cancer risk cancer screening cancer surgery cerebrovascular accident (side effect) clinical effectiveness decision support system drug efficacy endometrium cancer (drug therapy, prevention, side effect) evidence based practice health care personnel hormone substitution human informed consent Internet lifestyle modification lung embolism (side effect) mastectomy menopausal syndrome (drug therapy) osteoporosis (drug therapy) patient compliance patient education patient preference physical activity practice guideline randomized controlled trial (topic) risk assessment smoking cessation smoking habit spine fracture (drug therapy) unspecified side effect (side effect) women's health CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) tibolone (5630-53-5) EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2011412902 PUI L362220809 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 360 TITLE Breast cancer prevention: Predictors and outcomes of patient decision making AUTHOR NAMES O'Neill S. AUTHOR ADDRESSES (O'Neill S.) National Institutes of Health, Bethesda, United States. CORRESPONDENCE ADDRESS S. O'Neill, National Institutes of Health, Bethesda, United States. SOURCE Cancer Prevention Research (2010) 3:12 SUPPL. 2. Date of Publication: December 2010 CONFERENCE NAME AACR International Conference on Frontiers in Cancer Prevention Research CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2010-11-07 to 2010-11-10 ISSN 1940-6207 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Several options exist for breast cancer risk-reduction in women at moderate to high risk for the disease. However, cancer risk management decisions can be difficult. This is partially due to the competing risks, benefits and limitations of each management option, as well as related cognitive and emotional factors. This presentation draws on behavioral and decision-making research to detail risk management decision outcomes in the literature to date, examining reasons women may choose certain management options over others and why some options, such as uptake of chemoprevention, have not have taken hold in this population at rates previously expected. Data demonstrating the decisions made by women who receive BRCA1/2 test results and other women at moderate to high risk of the disease, including risk-reducing surgeries, screening, chemoprevention, and diet and physical activity will be presented. Potential cognitive and emotional variables related to decision outcomes will be reviewed. The talk will conclude with discussion of future research needs regarding decision support for current risk management options, as well as consideration of cognitive and emotional factors that may impact new risk management options currently on the horizon. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer prevention patient decision making EMTREE MEDICAL INDEX TERMS cancer risk chemoprophylaxis decision making decision support system diet emotion female human physical activity population risk risk management risk reduction screening surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70523836 DOI 10.1158/1940-6207.PREV-10-CN08-03 FULL TEXT LINK http://dx.doi.org/10.1158/1940-6207.PREV-10-CN08-03 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 361 TITLE Decision-making of the participants in cancer genetic counseling ORIGINAL (NON-ENGLISH) TITLE La toma de decisión de los participantes en consejo genético oncológico AUTHOR NAMES Cruzado J.A. AUTHOR ADDRESSES (Cruzado J.A., jacruzado@psi.ucm.es) Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, 28223-Madrid, Spain. CORRESPONDENCE ADDRESS J. A. Cruzado, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, 28223-Madrid, Spain. Email: jacruzado@psi.ucm.es SOURCE Psicooncologia (2010) 7:2-3 (341-362). Date of Publication: 2010 ISSN 1696-7240 1988-8287 (electronic) BOOK PUBLISHER Asociacion de Psicooncologia de Madrid, Buzon 24, Madrid, Spain. ABSTRACT We present an overview of most important variables that infl uence decision making of participants in cancer genetic counseling. It is studied the following factors: age, gender, personal an family history of cancer, medicalpatient communication, communication and support within family, risk perception, monitoring coping style and self-effi cacy, and genetic test outcomes. The decisions of participants in CGO are strongly infl uenced by beliefs, memories, family comparisons and narratives about cancer, that determine emotions, preferences and values that underlie their decisions, and must be taken into account during the process of genetic counseling. We review the decision aids applied in genetic counseling: Interactive, print, computer or internet. Research results show that decision aids are effective and useful. Also, participants accept and require these aids. Most decision aids are designed for breast / ovarian cancer, while in other types of hereditary cancer are scarce. The decision aids in genetic counseling are developed mainly in USA and Australia. We stress the importance of designing and implementing decisions aids in Spain and Latin America, in order to promote the active role of people at risk of familial cancer and shared decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making genetic counseling EMTREE MEDICAL INDEX TERMS anamnesis breast cancer coping behavior demography doctor patient relation emotion family history family interaction family relation genetic analysis health belief hereditary tumor human memory ovary cancer perception review self concept EMBASE CLASSIFICATIONS Cancer (16) Psychiatry (32) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2011459537 PUI L362363427 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 362 TITLE Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. AUTHOR NAMES Salgarello M. Visconti G. Barone-Adesi L. AUTHOR ADDRESSES (Salgarello M.) Department of Plastic and Reconstructive Surgery and the Breast Unit, Catholic University of Sacro Cuore, University Hospital Agostino Gemelli, Rome, Italy. (Visconti G.; Barone-Adesi L.) CORRESPONDENCE ADDRESS M. Salgarello, Department of Plastic and Reconstructive Surgery and the Breast Unit, Catholic University of Sacro Cuore, University Hospital Agostino Gemelli, Rome, Italy. Email: m.salgarello@mclink.it SOURCE Plastic and reconstructive surgery (2010) 126:5 (1460-1471). Date of Publication: Nov 2010 ISSN 1529-4242 (electronic) ABSTRACT Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction (adverse drug reaction) mastectomy EMTREE MEDICAL INDEX TERMS article esthetics female human methodology nipple patient satisfaction LANGUAGE OF ARTICLE English MEDLINE PMID 21042102 (http://www.ncbi.nlm.nih.gov/pubmed/21042102) PUI L360237043 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 363 TITLE Incorporating margin status information in treatment decisions for women with ductal carcinoma in situ: A decision analysis AUTHOR NAMES Wang S.-Y. Kuntz K. Tuttle T. Kane R. AUTHOR ADDRESSES (Wang S.-Y., wang1018@umn.edu; Kuntz K.; Kane R.) Department of Health Policy and Management, University of Minnesota, School of Public Health, 420 Delaware Street S.E. MMC 729, Minneapolis, MN 55455, United States. (Tuttle T.) Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States. CORRESPONDENCE ADDRESS S.-Y. Wang, Department of Health Policy and Management, University of Minnesota, School of Public Health, 420 Delaware Street S.E. MMC 729, Minneapolis, MN 55455, United States. Email: wang1018@umn.edu SOURCE Breast Cancer Research and Treatment (2010) 124:2 (393-402). Date of Publication: November 2010 ISSN 0167-6806 1573-7217 (electronic) BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT To integrate margin status information into the decision to undergo radiation therapy (RT) following breast-conserving surgery (BCS) for women with ductal carcinoma in situ (DCIS). We developed a decision-analytic Markov model to project quality-adjusted life years (QALYs) for a hypothetical cohort of 55-year-old women with DCIS over a lifetime horizon treated with or without RT following BCS. We estimated the transition probabilities of local DCIS and invasive recurrences based on the margin status (free, close, or positive) from a systematic literature review. Other probability estimates and utilities were collected from the published literature. Using the conditions defined in this model, expected QALYs after BCS alone were better than those after BCS with RT under the free-margin scenario (15.72 vs. 15.58) and worse in the close-margin (15.44 vs. 15.50) and positive-margin scenarios (15.20 vs. 15.33). The probability of receiving a salvage mastectomy varied from 10 to 28%, depending on margin status and treatment. One-way sensitivity analyses showed that the optimal treatment was sensitive to patients' preferences and RT side effects. Probabilistic sensitivity analyses revealed that BCS alone would be the best strategy in 54% of the cases under the free-margin scenario, 48% under the close-margin scenario, and 44% under the positive-margin scenario. This study illustrates that margin status is able to provide supplementary information on the decision of DCIS treatment. Our analyses also highlight the importance of patients' preferences in decision making. Our findings suggest that RT is not necessary for all patients with DCIS undergoing BCS. © 2010 Springer Science+Business Media, LLC. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery cancer radiotherapy intraductal carcinoma (radiotherapy, surgery, therapy) partial mastectomy patient decision making EMTREE MEDICAL INDEX TERMS adult article cancer recurrence cohort analysis controlled study female human mastectomy outcome assessment priority journal probability quality adjusted life year quality of life salvage therapy sensitivity analysis EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010642412 MEDLINE PMID 20848183 (http://www.ncbi.nlm.nih.gov/pubmed/20848183) PUI L51074069 DOI 10.1007/s10549-010-1166-7 FULL TEXT LINK http://dx.doi.org/10.1007/s10549-010-1166-7 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 364 TITLE Impact of a photograph-based educational tool on patient knowledge and satisfaction regarding cosmetic outcomes after breast Conservation Therapy: A Pilot Study AUTHOR NAMES Shah M.M. Peppercorn J. Lee C.N. Broadwater G. Horton J.K. AUTHOR ADDRESSES (Shah M.M.; Peppercorn J.; Broadwater G.; Horton J.K.) Duke University Medical Center, Durham, United States. (Lee C.N.) University of North Carolina, Chapel Hill, United States. CORRESPONDENCE ADDRESS M.M. Shah, Duke University Medical Center, Durham, United States. SOURCE International Journal of Radiation Oncology Biology Physics (2010) 78:3 SUPPL. 1 (S232-S233). Date of Publication: 1 Nov 2010 CONFERENCE NAME 52nd Annual Meeting of the American Society for Radiation Oncology CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2010-10-31 to 2010-11-04 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Consideration of breast-conserving therapy (BCT) vs. mastectomy for women with early stage breast cancer is complex. Knowledge of potential cosmetic outcomes after BCT and thus, treatment decision satisfaction may be enhanced with a photograph-based educational aid. Materials/Methods: We conducted a prospective, single-arm intervention consisting of photographs and information on incidence of BCT cosmetic outcomes accompanied by before and after self-administered surveys among newly diagnosed breast cancer patients eligible for BCT. Survey questions, developed and piloted at Duke, were administered initially after consultation with radiation oncology and included baseline demographics, importance of breast appearance, knowledge of potential cosmetic changes with BCT, and initial treatment decision satisfaction. Pertinent questions were repeated after review of the educational aid. Fishers exact test was used to compare responses, all statistical tests were two-sided. Results: Thirty patients completed the study: median age 58 (range, 42-87), 73% white, 23% African American, 50% reporting family/friends treated with radiation for breast cancer. The majority (26, 87%) of patients felt it was important (somewhat, quite a bit or very) to keep their breast, to look natural without clothes (24, 80%), to look natural with clothes (29, 97%), and to know how the breast would look after radiation (27, 90%). The percent of patients able to correctly identify the frequency of excellent/good and fair/poor cosmetic outcomes increased after the intervention. Sixteen patients (57%) correctly predicted the likelihood of good results prior to intervention, and 24 patients (83%) after (p = 0.05). Of the patients who improved their score, all felt it was important (quite a bit or very) that they keep their breast and that it looks natural in and out of clothes. Conversely, 15 patients (54%) correctly predicted the likelihood of poor outcomes prior to the intervention, and 25 (86%) after (p = 0.01). Six patients (22%) correctly identified breast size as the most noticeable change post-radiation on the first survey and 15 (52%) after (p = 0.03). The number of patients' feeling well-informed (quite a bit, very much) increased from 72% prior to viewing the photographs to 93% afterwards (p = NS). Decision satisfaction was high pre (97%; 28/29) and post (93%; 28/30) intervention (p = NS). Conclusions: This photograph-based educational tool appears to be a simple and effective way to improve patients' understanding of potential cosmetic outcomes after BCT, beyond that accomplished through standard radiation oncology consultation. Confirmation and refinement in a larger study is indicated. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast oncology patient photography pilot study satisfaction society therapy EMTREE MEDICAL INDEX TERMS African American arm breast cancer cancer patient clothing consultation female Fisher exact test mastectomy radiation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70277548 DOI 10.1016/j.ijrobp.2010.07.557 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2010.07.557 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 365 TITLE New strategies in ovarian cancer: Uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy AUTHOR NAMES Miller S.M. Roussi P. Daly M.B. Scarpato J. AUTHOR ADDRESSES (Miller S.M., suzanne.miller@fccc.edu; Scarpato J.) Psychosocial and Biobehavioral Medicine Program, Fox Chase Cancer Center, United States. (Roussi P.) Psychology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. (Daly M.B.) Department of Clinical Genetics, Fox Chase Cancer Center, Cheltenham, PA, United States. CORRESPONDENCE ADDRESS S. M. Miller, Psychosocial and Biobehavioral Medicine Program, Fox Chase Cancer Center, United States. Email: suzanne.miller@fccc.edu SOURCE Clinical Cancer Research (2010) 16:21 (5094-5106). Date of Publication: 1 Nov 2010 ISSN 1078-0432 1557-3265 (electronic) BOOK PUBLISHER American Association for Cancer Research Inc., 615 Chestnut Street, 17th Floor, Philadelphia, United States. ABSTRACT Here, we review factors associated with uptake of risk-reducing salpingo-oophorectomy by women at increased hereditary risk for ovarian cancer, as well as quality of life issues following surgery. Forty-one research studies identified through PubMed and PsychInfo met inclusion criteria. Older age, having had children, a family history of ovarian cancer, a personal history of breast cancer, prophylactic mastectomy, and BRCA1/2 mutation carrier status increase the likelihood of undergoing surgery. Psychosocial variables predictive of surgery uptake include greater perceived risk of ovarian cancer and cancer-related anxiety. Most women report satisfaction with their decision to undergo surgery and both lower perceived ovarian cancer risk and less cancer-related anxiety as benefits. Hormonal deprivation is the main disadvantage reported, particularly by premenopausal women who are not on hormonal replacement therapy (HRT). The evidence is mixed about satisfaction with the level of information provided prior to surgery, although generally, women report receiving insufficient information about the pros and cons of HRT. These findings indicate that when designing decision aids, demographic, medical history, and psychosocial variables need to be addressed in order to facilitate quality decision making. ©2010 AACR. EMTREE DRUG INDEX TERMS BRCA1 protein BRCA2 protein EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ovary cancer (surgery) salpingooophorectomy EMTREE MEDICAL INDEX TERMS age distribution anxiety cancer epidemiology cancer risk family history gene mutation genetic risk high risk population human mastectomy medical decision making patient satisfaction premenopause priority journal psychosocial care quality of life review risk reduction women's health EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010605906 MEDLINE PMID 20829330 (http://www.ncbi.nlm.nih.gov/pubmed/20829330) PUI L359887006 DOI 10.1158/1078-0432.CCR-09-2953 FULL TEXT LINK http://dx.doi.org/10.1158/1078-0432.CCR-09-2953 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 366 TITLE Do Patients Want Hypofractionated Radiotherapy for Breast Cancer? Results from an Urban Practice AUTHOR NAMES Lim K.H. Choo B. Earnest A. Wong L. Tey J. AUTHOR ADDRESSES (Lim K.H.; Choo B.; Wong L.; Tey J.) National University Hospital, Singapore, Singapore. (Earnest A.) Tan Tock Seng Hospital, Singapore, Singapore. CORRESPONDENCE ADDRESS K.H. Lim, National University Hospital, Singapore, Singapore. SOURCE International Journal of Radiation Oncology Biology Physics (2010) 78:3 SUPPL. 1 (S214). Date of Publication: 1 Nov 2010 CONFERENCE NAME 52nd Annual Meeting of the American Society for Radiation Oncology CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2010-10-31 to 2010-11-04 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Recently the long-term results of a Canadian randomized trial were presented which suggest that hypofractionationed breast radiotherapy (HBRT) offers equivalent rates of local control and late toxicity compared with standard fractionation. While most physicians feel it is safe to offer HBRT, it is not clear whether patients are accepting of HBRT given the 10-year median follow-up. This trial aims to determine what proportion of patients would choose HBRT and to explore potential patient characteristics and other factors that might influence this decision. This will aid in future workload and machine utilization planning. Materials/Methods: Advantages and disadvantages of two fractionation schedules 42.5 Gy in 16 fractions over 22 days or 50 Gy in 25 fractions over 35 days used in the Canadian breast cancer trial were discussed with patients with T1-T2 N0 M0 breast cancer using a decision board. Patients were asked to choose a fractionation schedule, and to give reasons for their choice. Patient demographics e.g. age, education level and traveling time to the hospital were also recorded. Results: Seventy-four patients were recruited (52% T1). Median age was 54 years old (36 yrs to 72 yrs), median distance from home to hospital was 9 km (2 km to 23 km) and median travel time was 20 min (5 min to 60 min). 59% had at least a high school education, 68% received government subsidized RT, 32% were unemployed and 16% lived alone. 47% of patients (95% confidence interval [CI] 36% to 58%) chose HBRT. Choice was related to increasing age (OR 1.10, 95% CI 1.03 to 1.15, p = 0.002). Patients between 50 yrs to 60 yrs were 5 times (95% CI 1.72 to 17, p = 0.004) and patients over 60 yrs were 10.5 times (95% CI, 2.4 to 46.7, p<0.001) more likely to choose HBRT compared to patients less than 50 yrs. Variables such as travel time, distance from hospital, employment status, cost of treatment and social support were not related to patient choice. HBRT was chosen for lower cost (45%) and increased convenience (92%), whilst standard fractionation was chosen for the longer follow- up (100%). Conclusions: While older patients were more accepting of HBRT, this trial indicates that length of follow-up is still of concern to patients. Given that no patient had to travel for longer than 60 min to receive RT, it would be interesting to repeat this study in a rural setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer oncology patient radiotherapy society EMTREE MEDICAL INDEX TERMS breast confidence interval education employment status follow up fractionation government high school hospital machine physician planning social support toxicity travel workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70277508 DOI 10.1016/j.ijrobp.2010.07.515 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2010.07.515 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 367 TITLE The Communication and Care Plan: a novel approach to patient-centered clinical information systems. AUTHOR NAMES Hogarth M. Hajopoulos K. Young M. Cowles N. Churin J. Hornthal B. Esserman L. AUTHOR ADDRESSES (Hogarth M.) Department of Pathology and Laboratory Medicine, University of California, Davis, USA. (Hajopoulos K.; Young M.; Cowles N.; Churin J.; Hornthal B.; Esserman L.) CORRESPONDENCE ADDRESS M. Hogarth, Department of Pathology and Laboratory Medicine, University of California, Davis, USA. SOURCE Journal of biomedical informatics (2010) 43:5 Suppl (S6-8). Date of Publication: Oct 2010 ISSN 1532-0480 (electronic) ABSTRACT The US health care system and its information access models are organized around institutions and providers. Patient-centered functionality is rarely present in prevailing information systems and, if present, it typically does not ideally support shared decision making about important treatment events. We sought to better understand the functional needs of providers and patients around the process of care plan decision making, and used this information to develop a prototype decision support tool, using women with newly diagnosed breast cancer as our clinical scenario. This paper describes the user-centered design process we undertook and the resulting prototype system, the Communication and Care Plan (CCP). Copyright © 2010 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electronic medical record patient care telemedicine EMTREE MEDICAL INDEX TERMS article breast tumor (therapy) computer interface decision support system female hospital management human Internet methodology LANGUAGE OF ARTICLE English MEDLINE PMID 20937486 (http://www.ncbi.nlm.nih.gov/pubmed/20937486) PUI L360258066 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 368 TITLE Dosimetric analysis of radiation dose to latissimus dorsi myocutaneous flap in women undergoing adjuvant radiotherapy for early breast cancer-short report : Radiation dose to latissimus dorsi myocutaneous flap AUTHOR NAMES Albuquerque K. Sieber D. Hiro M. Saeed H. Surfield G. Shankaran V. Cimino V. AUTHOR ADDRESSES (Albuquerque K., kalbuqu@lumc.edu; Sieber D.; Hiro M.; Saeed H.; Surfield G.; Shankaran V.; Cimino V.) Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL 60153, United States. CORRESPONDENCE ADDRESS K. Albuquerque, Department of Radiation Oncology, LUMC, Maguire Center 2944, 2160S.1st Ave, Maywood, IL 60153, United States. Email: kalbuqu@lumc.edu SOURCE European Journal of Plastic Surgery (2010) 33:5 (271-275). Date of Publication: October 2010 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Breast reconstruction following mastectomy often involves the use of regional myocutaneous flaps such as the latissimus dorsi (LDM) and transverse rectus abdominus flaps. A history of previous radiation to the skin paddle of the myocutaneous flap planned for breast reconstruction may cause the plastic surgeon to consider using an alternative muscle flap which has not received radiation. To aid decision-making in the setting of previous radiation, we prospectively assessed the dose given to the latissimus myocutaneous flap of a small series of seven women who were to undergo adjuvant 3-D conformal radiation therapy after breast conservation surgery (four) or mastectomy (three). The skin paddles of this flap were marked using wires prior to the planning CT scan required for 3-D conformal therapy. Radiation dose to the skin paddles was minimal but the LD muscle dose averaged 888 cGy. The thoracodorsal artery received the highest doses of radiation averaging 2,750 cGy with 55.5% of the artery receiving at least 2,500 cGy and 25.3% of the artery receiving at least 4,500 cGy which was almost a prescription radiation dose to the whole breast. The clinical implications of this level of radiation dose to the arterial pedicle are likely minimal because it is a peripheral small blood vessel. The surgeon and the radiation oncologist should be aware of this as a potential factor and its possible effects on breast reconstruction outcome particularly in the midst of other predictors of poor vascularity such as smoking, diabetes, or peripheral vascular disease. We plan to study further the dose to LDM flap in a larger series of women. However, information about dose to planned myocutaneous flap in the setting of history of previous breast radiation can be easily obtained from the radiation plan and should be ascertained prior to breast reconstruction. © 2010 Springer-Verlag. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) cancer radiotherapy dosimetry early cancer (radiotherapy, surgery) latissimus dorsi flap radiation dose EMTREE MEDICAL INDEX TERMS article breast reconstruction cancer adjuvant therapy cancer surgery clinical article clinical decision making computer assisted tomography female human mastectomy priority journal prospective study skin thoracodorsal artery EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010542412 PUI L50864182 DOI 10.1007/s00238-010-0419-3 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-010-0419-3 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 369 TITLE MyOncofertility.org: A web-based patient education resource supporting decision making under severe emotional and cognitive overload AUTHOR NAMES Jona K. Gerber A. AUTHOR ADDRESSES (Jona K., kjona@northwestern.edu) Office of STEM Education Partnerships-Learning Sciences and Computer Science, School of Education and Social Policy, Northwestern University, Evanston, IL, United States. (Gerber A., gerber.post@gmail.com) Center for Bioethics, Science and Society, Northwestern University, Chicago, IL, United States. CORRESPONDENCE ADDRESS A. Gerber, Center for Bioethics, Science and Society, Northwestern University, Chicago, IL, United States. Email: gerber.post@gmail.com EDITORS Woodruff T.K. Rodriguez S Campo-Engelstein L Zoloth L SOURCE Cancer Treatment and Research (2010) 156 (345-361). Date of Publication: 2010 Oncofertility: Ethical, Legal, Social, and Medical Perspectives, Book Series Title: ISSN 0927-3042 ISBN 9781441965172 (volume) BOOK PUBLISHER Springer Netherlands, Van Godewijckstraat 30, Dordrecht, Netherlands. ABSTRACT As these scenarios illustrate, cancer patients and their families face a crucible of high-stake decisions during a time of extreme stress. They must cope with the shock and fear that attends a cancer diagnosis and navigate a complex set of treatment options. Then there is the often neglected issue of fertility preservation (FP) for those of reproductive age. Many cancer treatments, including surgery, radiation, and chemotherapy, carry significant risks of irreversibly compromising a patient's fertility. Patients are often unaware of these risks and in far too many cases, their health-care providers (HCPs) do not adequately inform them of these risks or available fertility preserving or sparing options. © 2010 Springer Science+Business Media, LLC. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cognition decision support system emotional stress patient education web browser EMTREE MEDICAL INDEX TERMS access to information article breast cancer cancer chemotherapy cancer diagnosis cancer patient cancer radiotherapy cancer surgery cancer therapy clinical decision making coping behavior cryopreservation fear female fertility female infertility (complication) human in vitro fertilization Internet male infertility mass medium oocyte retrieval osteosarcoma pelvic girdle priority journal reproductive health risk assessment software sperm preservation uncertainty EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Urology and Nephrology (28) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010485406 MEDLINE PMID 20811846 (http://www.ncbi.nlm.nih.gov/pubmed/20811846) PUI L359486379 DOI 10.1007/978-1-4419-6518-9_26 FULL TEXT LINK http://dx.doi.org/10.1007/978-1-4419-6518-9_26 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 370 TITLE Green or purple? Art therapy as an aid in medical decision making AUTHOR NAMES Johanna C.C. Gurion B. AUTHOR ADDRESSES (Johanna C.C.; Gurion B.) University of the Negev, Israel. CORRESPONDENCE ADDRESS C.C. Johanna, University of the Negev, Israel. SOURCE Journal of Psychosomatic Obstetrics and Gynecology (2010) 31 SUPPL. 1 (67). Date of Publication: October 2010 CONFERENCE NAME Abstract of 15th International Congress of ISPOG CONFERENCE LOCATION Venezia, Italy CONFERENCE DATE 2010-10-28 to 2010-10-30 ISSN 0167-482X BOOK PUBLISHER Informa Healthcare ABSTRACT The introduction of written informed consent in the 1970's created a culture of shared decision making between doctors and patients. This responsibility can lead to decisional conflict, in which an individual is emotionally distraught and preoccupied with the decision making process. This can occur frequently in gyno-oncological patients when the potential benefits and risks of a certain treatment are not precisely distinct from other treatments offered. Art therapy is often utilized as a part of psycho-social support of the psycho-oncology team. There has been some anecdotal evidence that points to the reduction of anxiety and pain related to cancer in individuals participating in art therapy. Art therapy also assists individuals in expressing parts of themselves less accessible or difficult to express in words. This research utilizes a case study approach to take an in depth look at the decision making process of a group of oncological patients through art making. The art therapy group presented took place once a week at a support center for cancer patients. The majority of participants were diagnosed with breast or ovarian cancer at the time. Some of the participants chose to reflect on past decisions made using art. Others, used art to assist them in the active process of decision making. Art Therapy is offered as a psycho-oncological modality to assist in the decision making process often encountered by the gyno-oncological patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) art therapy medical decision making EMTREE MEDICAL INDEX TERMS anxiety breast cancer patient case study decision making informed consent neoplasm oncology ovary cancer pain patient physician responsibility risk social support LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70302156 DOI 10.3109/0167482x.2010.536387 FULL TEXT LINK http://dx.doi.org/10.3109/0167482x.2010.536387 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 371 TITLE Synoptic operative record for point of care outcomes: A leap forward in knowledge translation AUTHOR NAMES Mack L.A. Dabbs K. Temple W.J. AUTHOR ADDRESSES (Mack L.A., lloyd.mack@albertahealthservices.ca; Temple W.J.) Department of Surgery and Oncology, University of Calgary, 1331-29th Street NW, Calgary, AB T2N 4N2, Canada. (Dabbs K.) Department of Surgery, University of Edmonton, 166 Meadowlark Health Centre, Edmonton, AB T5R 5W9, Canada. CORRESPONDENCE ADDRESS L. A. Mack, Department of Surgery and Oncology, University of Calgary, 1331-29th Street NW, Calgary, AB T2N 4N2, Canada. Email: lloyd.mack@albertahealthservices.ca SOURCE European Journal of Surgical Oncology (2010) 36:SUPPL. 1 (S44-S49). Date of Publication: September 2010 ISSN 0748-7983 1532-2157 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Introduction: Modern information technology coupled with synoptic methodology allows point of care, real time outcomes generation. Our objective was to review province-wide breast cancer surgery outcomes from a prospective synoptic operative record to demonstrate its value in knowledge translation. Methods: All synoptic reports for breast cancer procedures from 2006 until March 2010 were reviewed and descriptively analyzed. Key outcomes included frequency of breast cancer procedures captured over time, methods of breast cancer detection, clinical staging, method of axillary staging, breast conservation and reconstruction rates. Further analysis involved important decision-making for mastectomy and resource allocation for surgery. Results: Four thousand nine hundred fifty-five breast cancer procedures were recorded synoptically; greater than 80% of cases provincially. Method of breast cancer detection was 49%, 45% and 4% by screening radiology, patient or family, and physician, respectively. Pathologic diagnoses were via core or mammotome biopsy in 94%; nearly half of all patients were clinical Stage I at time of operation. Overall rate of breast conservation was 48%. Of the 65% who had no contra-indication to breast conservation surgery, 76% had breast conservation and 4% had primary reconstruction. Of those having mastectomy, one third were due to patient choice. Seventy-nine percent had sentinel node staging, 18% had full axillary dissection and 3% had no axillary staging. Conclusion: A new paradigm of creating medical records using synoptic electronic templates allows prospective outcomes generation at point of care by the surgeon which is unparalleled in its depth of surgical detail capturing surgical decision-making. © 2010 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast surgery EMTREE MEDICAL INDEX TERMS article breast biopsy breast reconstruction cancer diagnosis cancer staging clinical decision making human human tissue lymph node dissection major clinical study mastectomy patient care priority journal sentinel lymph node surgical technique treatment outcome EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010441980 MEDLINE PMID 20609548 (http://www.ncbi.nlm.nih.gov/pubmed/20609548) PUI L50980648 DOI 10.1016/j.ejso.2010.06.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2010.06.005 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 372 TITLE Development of a decision aid and first impressions: A pilot study for older women with stage 1 hormone sensitive breast cancer AUTHOR NAMES Dalimonte L. AUTHOR ADDRESSES (Dalimonte L.) Odette Cancer Centre, Toronto, Canada. CORRESPONDENCE ADDRESS L. Dalimonte, Odette Cancer Centre, Toronto, Canada. SOURCE Journal of Radiotherapy in Practice (2010) 9:3 (187-188). Date of Publication: September 2010 CONFERENCE NAME 5th Radiotherapy in Practice Conference CONFERENCE LOCATION Sheffield, United Kingdom CONFERENCE DATE 2010-10-08 to 2010-10-10 ISSN 1460-3969 BOOK PUBLISHER Cambridge University Press ABSTRACT Purpose:: To develop a decision aid (DA) prototype for post lumpectomy women 70 years and older with Stage I hormone sensitive invasive breast cancer, and to conduct a preliminary testing of the DA to ensure that the format and information presented is clear and acceptable to patients. Methods and materials: During the developmental phase of a prototype of the DA, we incorporated feedback from the focus groups that were conducted with 16 older women with Stage I breast cancer. In addition, we applied the Ottawa Decisional Support Framework to ensure that the information on the DA was evidence-based, practical, and understandable by the patients. The final format of the DA was evaluated in one-on-one interviews with 12 Stage I, breast cancer patients in the same age group. All the participants completed their adjuvant radiation therapy at the Odette Cancer Centre. After the interviews, the participants received a pocket size version of the DA and an acceptability questionnaire. The acceptability questionnaire investigated patients' understanding of the information provided, length of the DA, its visual appearance and the graphics. In addition, patients were encouraged to provide any further comments regarding the format and content of the DA prototype. Results: All participants rated the DA as extremely acceptable, found the format and content clear and informative and had desired such a tool when they were facing their treatment decisions. Four (4/12) women felt that although the DA booklet thoroughly presented all pertinent information, the content should be better organized. In addition, some women (4/12) felt that the language of the DA needed to be clarified and simplified for the lay audience who would be using the tool. The biggest concern from all participants was the timing of the delivery of the tool. Many women expressed the need for the tool to be administered prior to surgery or immediately after to allow for time to process the information presented in the DA and to generate questions for physician consults. Conclusions: Based on patients' feedback, we revised the content of the DA. We also simplified the language in several parts of the DA that was suggested by the participants. The detailed analysis of the acceptability questionnaires will be presented at the meeting. The findings of this study indicate that older breast cancer patients' informational needs are complex. The DA can be a helpful educational tool in the decisionmaking process for treatment in this group of low risk breast cancer patients. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hormone EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer female pilot study radiotherapy EMTREE MEDICAL INDEX TERMS cancer center cancer patient evidence based practice feedback system groups by age information processing interview language partial mastectomy patient physician questionnaire risk surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70302688 DOI 10.1017/S1460396910000385 FULL TEXT LINK http://dx.doi.org/10.1017/S1460396910000385 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 373 TITLE Patients' knowledge about 9 common health conditions: the DECISIONS survey. AUTHOR NAMES Fagerlin A. Sepucha K.R. Couper M.P. Levin C.A. Singer E. Zikmund-Fisher B.J. AUTHOR ADDRESSES (Fagerlin A.) VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. (Sepucha K.R.; Couper M.P.; Levin C.A.; Singer E.; Zikmund-Fisher B.J.) CORRESPONDENCE ADDRESS A. Fagerlin, VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. Email: fagerlin@med.umich.edu SOURCE Medical decision making : an international journal of the Society for Medical Decision Making (2010) 30:5 Suppl (35S-52S). Date of Publication: 2010 Sep-Oct ISSN 1552-681X (electronic) ABSTRACT To make informed decisions, patients must have adequate knowledge of key decision-relevant facts. To determine adults' knowledge about information relevant to common types of medication, screening, or surgery decisions they recently made. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted between November 2006 and May 2007. A total of 2575 English-speaking adults aged 40 y or older who reported having discussed the following medical decisions with a health care provider within the previous 2 y: prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; or surgeries for knee/hip replacement, cataracts, or lower back pain. Participants answered knowledge questions and rated the importance of their health care provider, family/friends, and the media as sources of information. Accuracy rates varied widely across questions and decision contexts. For example, patients considering cataract surgery were more likely to correctly estimate recovery time than those patients considering lower back pain or knee/hip replacement (78% v. 29% and 39%, P < 0.001). Similarly, participants were more knowledgeable of facts about colorectal cancer screening than those who were asked about breast or prostate cancer. Finally, respondents were consistently more knowledgeable on comparable questions about blood pressure medication than cholesterol medication or antidepressants. The impact of demographic characteristics and sources of information also varied substantially. For example, blacks had lower knowledge than whites about cancer screening decisions (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.43, 0.75; P = 0.001) and medication (OR = 0.77; 95% CI = 0.60, 0.97; P = 0.03) even after we controlled for other demographic factors. The same was not true for surgical decisions. The questions did not measure all knowledge relevant to informed decision making, were subject to recall biases, and may have assessed numeracy more than knowledge. Patient knowledge of key facts relevant to recently made medical decisions is often poor and varies systematically by decision type and patient characteristics. Improving patient knowledge about risks, benefits, and characteristics of medical procedures is essential to support informed decision making. EMTREE DRUG INDEX TERMS prescription drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health patient education patient participation EMTREE MEDICAL INDEX TERMS adult aged article confidence interval cross-sectional study decision making early diagnosis education educational status female general surgery human male middle aged multivariate analysis neoplasm (diagnosis, drug therapy, surgery) risk statistical model LANGUAGE OF ARTICLE English MEDLINE PMID 20881153 (http://www.ncbi.nlm.nih.gov/pubmed/20881153) PUI L360272758 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 374 TITLE Women's constructions of the 'right time' to consider decisions about risk-reducing mastectomy and risk-reducing oophorectomy AUTHOR NAMES Howard A.F. Bottorff J.L. Balneaves L.G. Kim-Sing C. AUTHOR ADDRESSES (Howard A.F., fuchsia.howard@ubc.ca) School of Population and Public Health, University of British Columbia, Canada. (Bottorff J.L., joan.bottorff@ubc.ca) Faculty of Health and Social Development, University of British Columbia Okanagan, Canada. (Balneaves L.G., lynda.balneaves@ubc.ca) School of Nursing, University of British Columbia, Canada. (Kim-Sing C., ckimsing@bccancer.bc.ca) British Columbia Cancer Agency and Faculty of Surgery, University of British Columbia, Canada. CORRESPONDENCE ADDRESS A.F. Howard, School of Population and Public Health, University of British Columbia, Canada. Email: fuchsia.howard@ubc.ca SOURCE BMC Women's Health (2010) 10 Article Number: 24. Date of Publication: 5 Aug 2010 ISSN 1472-6874 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: Women who are notified they carry a BRCA1/2 mutation are presented with surgical options to reduce their risk of breast and ovarian cancer, including risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). Growing evidence suggests that a sub-group of women do not make decisions about RRM and RRO immediately following genetic testing, but rather, consider these decisions years later. Women's perspectives on the timing of these decisions are not well understood. Accordingly, the purpose of this research was to describe how women construct the 'right time' to consider decisions about RRM and RRO.Methods: In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods.Results: The time that lapsed between receipt of genetic test results and receipt of RRM or RRO ranged from three months to nine years. The findings highlighted the importance of considering decisions about RRM and RRO one at a time. The women constructed the 'right time' to consider these decisions to be when: (1) decisions fit into their lives, (2) they had enough time to think about decisions, (3) they were ready emotionally to deal with the decisions and the consequences, (4) all the issues and conflicts were sorted out, (5) there were better options available, and (6) the health care system was ready for them.Conclusions: These findings offer novel insights relevant to health care professionals who provide decision support to women considering RRM and RRO. © 2010 Howard et al; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making mastectomy ovariectomy risk reduction EMTREE MEDICAL INDEX TERMS article comparative study emotion female health care system heterozygote human qualitative analysis EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010470006 MEDLINE PMID 20687957 (http://www.ncbi.nlm.nih.gov/pubmed/20687957) PUI L51027084 DOI 10.1186/1472-6874-10-24 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6874-10-24 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 375 TITLE Are you SURE? Assessing patient decisional conflict with a 4-item screening test AUTHOR NAMES Légaré F. Kearing S. Clay K. Gagnon S. D'Amours D. Rousseau M. O'Connor A. AUTHOR ADDRESSES (Légaré F., france.legare@mfa.ulaval.ca; D'Amours D.; Rousseau M.) Department of Family Medicine, Laval University, Quebec city, QC, Canada. (Légaré F., france.legare@mfa.ulaval.ca) Department of Implementation of Shared Decision Making in Primary Care, Canada. (Kearing S.; Clay K.) Dartmouth Institute for Health Policy and Clinical Practice, NH, United States. (Légaré F., france.legare@mfa.ulaval.ca; Gagnon S.) CHUQ Research Centre, Hôpital St.-François d'Assise, 10 rue de l'Espinay, Quebec city, QC G1L 3L5, Canada. (O'Connor A.) School of Nursing, University of Ottawa, ON, Canada. CORRESPONDENCE ADDRESS F. Légaré, CHUQ Research Centre, Hôpital St.-François d'Assise, 10 rue de l'Espinay, Quebec city, QC G1L 3L5, Canada. Email: france.legare@mfa.ulaval.ca SOURCE Canadian Family Physician (2010) 56:8 (e308-e314). Date of Publication: August 2010 ISSN 0008-350X BOOK PUBLISHER College of Family Physicians of Canada, 2630 Skymark Avenue, Mississauga Ont., Canada. ABSTRACT OBJECTIVE: To assess the reliability and validity of the 4-item SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test for decisional conflict in patients. DESIGN: Cross-sectional study. SETTING: Four family medicine groups in Quebec and 1 rural academic medical centre in New Hampshire. PARTICIPANTS: One hundred twenty-three French-speaking pregnant women considering prenatal screening for Down syndrome and 1474 English-speaking patients referred to watch condition-specific video decision aids. MAIN OUTCOME MEASURES: Cronbach α was used to assess the reliability of SURE. A factorial analysis was performed to assess its unidimensionality. The Pearson correlation coefficient was computed between SURE and the Decisional Conflict Scale to assess concurrent validation. A t test procedure comparing the SURE scores of patients who had made decisions with the scores of those who had not was used to assess construct validation. RESULTS: Among the 123 French-speaking pregnant women, 105 (85%) scored 4 out of 4 (no decisional conflict); 10 (8%) scored 3 (≤ 3 indicates decisional conflict); 7 (6%) scored 2; and 1 (1%) scored 1. Among the 1474 English-speaking treatment-option patients, 981 (67%) scored 4 out of 4; 272 (18%) scored 3; 147 (10%) scored 2; 54 (4%) scored 1; and 20 (1%) scored 0. The reliability of SURE was moderate (Cronbach α of 0.54 in French-speaking pregnant women and 0.65 in treatment-option patients). In the group of pregnant women, 2 factors accounted for 72% of the variance. In the treatment-option group, 1 factor accounted for 49% of the variance. In the group of pregnant women, SURE correlated negatively with the Decisional Conflict Scale (r = -0.46; P < .0001); and in the group of treatment-option patients, it discriminated between those who had made a choice for a treatment and those who had not (P < .0001). CONCLUSION: The SURE screening test shows promise for screening for decisional conflict in both French- and English-speaking patients; however, future studies should assess its performance in a broader group of patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) conflict patient assessment patient decision making screening test EMTREE MEDICAL INDEX TERMS adult article audiovisual equipment breast cancer (surgery) breast reconstruction Canada chronic pain comprehension controlled study cross-sectional study decision making demography Down syndrome English as a second language factor analysis female France hip osteoarthritis human intervertebral disk hernia knee osteoarthritis low back pain major clinical study pregnant woman prenatal screening prostate cancer questionnaire reliability risk benefit analysis rural area scoring system United States university hospital validity vertebral canal stenosis EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Arthritis and Rheumatism (31) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2010493610 MEDLINE PMID 20705870 (http://www.ncbi.nlm.nih.gov/pubmed/20705870) PUI L359511335 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 376 TITLE Patient Decisions about Breast Cancer Chemoprevention: A Systematic Review and Meta-Analysis AUTHOR NAMES Ropka M.E. Keim J. Philbrick J.T. AUTHOR ADDRESSES (Ropka M.E., mer2e@virginia.edu; Keim J.; Philbrick J.T.) CORRESPONDENCE ADDRESS M. E. Ropka, Department of Public Health Sciences, University of Virginia, School of Medicine, Box 800717, Charlottesville, VA 22908, United States. Email: mer2e@virginia.edu SOURCE Journal of Clinical Oncology (2010) 28:18 (3090-3095). Date of Publication: 20 Jun 2010 ISSN 0732-183X 1527-7755 (electronic) BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Women at high risk of breast cancer face the complex decision of whether to take tamoxifen or raloxifene for breast cancer chemoprevention. We investigated what is known about decisions of women regarding chemoprevention. Methods: Using MEDLINE, CINAHL, and PSYCINFO, plus reviewing reference lists of relevant articles, in December 2009 we identified 13 studies that addressed patient decisions about breast cancer chemoprevention, were published in 1995 or later, were peer-reviewed primary clinical studies, and reported rates at which participants showed interest in (hypothetical uptake) or accepted (real uptake) chemoprevention medications. Results: Nine studies provided information about hypothetical breast cancer chemoprevention decisions (mean uptake rate, 24.7%) and five provided information about real decisions (mean uptake rate, 14.8%). The range of rates was wide, and each of the hypothetical uptake studies assessed interest differently. A logistic regression model found significant correlation with uptake of decision type (hypothetical versus real, odds ratio [OR] = 1.65; 95% CI, 1.26 to 2.16), educational or decision support intervention (provided v not, OR = 0.21; 95% CI, 0.17 to 0.27), and cohort risk for breast cancer (high-risk v general population, OR = 0.65; 95% CI, 0.56 to 0.75). Perceived vulnerability to breast cancer was consistently correlated with increased uptake, and concern for adverse effects was correlated with reduced uptake. All studies used a correlational/descriptive design, and most studies used convenience sampling strategies. Conclusion: Breast cancer chemoprevention uptake rates are low and variation is wide. Hypothetical uptake rates are higher than real uptake, and interventions markedly reduce uptake. Research is needed that uses reproducible sampling methods and examines decision support strategies that lead to quality decisions. © 2010 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, prevention) meta analysis (topic) patient decision making EMTREE MEDICAL INDEX TERMS cancer chemotherapy cancer risk chemoprophylaxis decision support system human medical information priority journal review systematic review EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011103917 MEDLINE PMID 20458026 (http://www.ncbi.nlm.nih.gov/pubmed/20458026) PUI L361298293 DOI 10.1200/JCO.2009.27.8077 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2009.27.8077 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 377 TITLE Surgeon influence on patient appraisal of ASCO breast cancer quality indicators AUTHOR NAMES Hawley S.T. Hamilton A.S. Graff J. Katz S.J. AUTHOR ADDRESSES (Hawley S.T.; Hamilton A.S.; Graff J.; Katz S.J.) CORRESPONDENCE ADDRESS S.T. Hawley, SOURCE Journal of Clinical Oncology (2010) 28:15 SUPPL. 1. Date of Publication: 20 May 2010 CONFERENCE NAME 2010 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2010-06-04 to 2010-06-08 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: There has been no research evaluating provider level variation in patient appraisal of 3 key indicators of quality breast cancer care defined by ASCO: timely access, care coordination, and decision satisfaction. Methods: 3,133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 and reported to the Detroit and Los Angeles SEER registries were identified and surveyed after diagnosis. Latina and African American (AA) women were oversampled (N=2,268, response rate 72.4%). Patient survey and SEER data were merged with surveys of attending surgeons (N=311). Three multi-item patient-reported scales were adapted from ASCO's national initiative on cancer care quality: 1) timely access to care; 2) perceived care coordination; 3) decision satisfaction. Each continuous outcome (range 1 to 5) was analyzed using hierarchical regression to determine the amount of total variation explained by surgeons. Subsequent stepwise models controlled for patient factors (clinical and demographic), surgeon characteristics (specialization, gender, age), and two novel surgeon practice process measures (multidisciplinary communication scale, patient decision support scale). Results: Mean scores for the 3 outcomes were 4.2, 3.9 and 4.1 for access, coordination, and decision satisfaction. Individual surgeons explained a very small amount of the total variation in patient-reported timely access (4.7%), care coordination (3.8%), and decision satisfaction (1.3%) after controlling for patient factors. Adding surgeon characteristics and practice process measures to the models did not substantially affect between-surgeon variation in any of the outcomes (Table). Conclusions: Patients' appraisals of ASCO-based quality indicators for breast cancer were generally high. There was little surgeon influence on total variation in quality scores after controlling for patient factors. Surgeon practice processes appear to contribute minimally to patient perceptions of these quality measures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer oncology patient society surgeon EMTREE MEDICAL INDEX TERMS African American decision support system diagnosis female gender hospital patient interpersonal communication model neoplasm register satisfaction specialization United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70260239 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 378 TITLE Decision analysis: Excision alone versus excision plus radiation therapy for ductal carcinoma in situ AUTHOR NAMES Punglia R.S. Wong J.S. Burstein H.J. Weeks J.C. AUTHOR ADDRESSES (Punglia R.S.; Wong J.S.; Burstein H.J.; Weeks J.C.) Dana-Farber Cancer Institute, Boston, United States. CORRESPONDENCE ADDRESS R.S. Punglia, Dana-Farber Cancer Institute, Boston, United States. SOURCE Journal of Clinical Oncology (2010) 28:15 SUPPL. 1. Date of Publication: 20 May 2010 CONFERENCE NAME 2010 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2010-06-04 to 2010-06-08 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: The benefit of adding radiation therapy (RT) after excision of noninvasive carcinoma of the breast or ductal carcinoma in situ (DCIS) is widely debated. The management of DCIS was identified as one of the highest-priority topics in the Institute of Medicine's list of areas in need of comparative effectiveness research. Methods: Using available data about the events following recurrence, we created a Markov model to compare two different treatment choices in patients with DCIS, excision alone versus excision plus RT, to uncover the magnitude of potential benefits and disadvantages of each strategy. Risk of recurrence for each arm was derived from the EORTC randomized trial. The model was run for 3 age cohorts: 45, 60, 75 years of age at diagnosis. Variables potentially able to affect model results including risks of recurrence were studied in sensitivity analyses. Results: In all age groups, RT for DCIS was associated with a slight improvement in invasive disease-free, disease-free, and overall survival (Table). However, RT decreased the chance of having both breasts intact over a patient's lifetime. On average, we calculated that RT improved invasive disease-free survival by 18.5 months for a 45-year-old woman but decreased her chance of having both breasts by 11.3%. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed model results to be robust over a wide range of values for key parameters. Conclusions: Our analysis reveals that while RT increases invasive disease-free, disease-free, and overall survival, the magnitude of these benefits is quite modest, especially in older women. RT also increases the likelihood of eventual mastectomy. Patient age and preferences should therefore be considered when deciding to add or forgo RT for DCIS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) excision intraductal carcinoma oncology radiotherapy society EMTREE MEDICAL INDEX TERMS arm breast carcinoma in situ comparative effectiveness diagnosis disease free survival female groups by age lifespan mastectomy model overall survival patient risk sensitivity analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70257921 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 379 TITLE Facilitating cancer patients' decision making about breast reconstruction: The feasibility of BRECONDA, an interactive, computer-based intervention AUTHOR NAMES Harcourt D. Williamson H. Sherman K. Boyages J. Lam T. Cawthorn S. AUTHOR ADDRESSES (Harcourt D.; Williamson H.) Centre for Appearance Research, Dept of Psychology, University of the West of England, Bristol, United Kingdom. (Sherman K.) Dept of Psychology, Macquarie University, Sydney, Australia. (Sherman K.; Boyages J.; Lam T.) Westmead Breast Cancer Institute, Sydney, Australia. (Cawthorn S.) Breast Care Centre, Frenchay Hospital, North Bristol NHS Trust, Bristol, United Kingdom. CORRESPONDENCE ADDRESS D. Harcourt, Centre for Appearance Research, Dept of Psychology, University of the West of England, Bristol, United Kingdom. SOURCE Psycho-Oncology (2010) 19 SUPPL. 3 (S4). Date of Publication: May 2010 CONFERENCE NAME British Psychosocial Oncology Society 2009 Conference CONFERENCE LOCATION Cardiff, United Kingdom CONFERENCE DATE 2009-12-03 to 2009-12-04 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Background: Choosing whether or not to undergo breast reconstruction involves processing complex information, typically soon after receiving a diagnosis of breast cancer. Research shows that some women find it difficult to make this complicated decision and may later regret their choice. In Australia, we developed 'Breconda', a theoretically- based, interactive computer-based decision aid that aims to facilitate this choice and reduce post- decisional regret. Aims: To gain user feedback and evaluation of the decision aid and to identify any revisions required to meet the needs of UK NHS breast cancer patients. Methods: Using mixed methods, 20 mastectomy patients who had previously elected for or against breast reconstruction and 8 health professionals with expertise in breast cancer care rated the decision aid on Likert scales and provided detailed feedback during individual face-to- face interviews. Qualitative data was subjected to a thematic analysis. Results: Likert scale ratings (5 = high; 1 = low) showed the intervention was considered very useful (mean 4.71), contained relevant (mean 4.52) and high quality information (mean 4.24). All participants gave very positive feedback on its potential use and offered suggestions for improvements relating to presentation and content. The variety of participants' responses illustrate the complexity of meeting individuals' information and support needs during decision making. Conclusion: The intervention has been well-received by patients and health professionals and could usefully support decision making. This presentation will highlight the need for a full RCT to evaluate its effectiveness and the challenges of supporting patient decision making about breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer patient computer decision making oncology society EMTREE MEDICAL INDEX TERMS Australia breast cancer diagnosis feedback system female health practitioner interview mastectomy patient patient decision making positive feedback processing thematic analysis United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70180421 DOI 10.1002/pon.1785 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1785 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 380 TITLE Women's constructions of the 'right time' to consider decisions about risk-reducing mastectomy and risk-reducing oophorectomy AUTHOR NAMES Howard A.F. Bottorff J.L. Balneaves L.G. Kim-Sing C. AUTHOR ADDRESSES (Howard A.F.; Balneaves L.G.) University of British Columbia, Vancouver, Canada. (Bottorff J.L.) University of British Columbia Okanagan, Kelowna, Canada. (Kim-Sing C.) University of British Columbia, British Columbia Cancer Agency, Vancouver, Canada. CORRESPONDENCE ADDRESS A.F. Howard, University of British Columbia, Vancouver, Canada. SOURCE Psycho-Oncology (2010) 19 SUPPL. 2 (S70). Date of Publication: May 2010 CONFERENCE NAME IPOS 12th World Congress of Psycho-Oncology CONFERENCE LOCATION Quebec City, QC, Canada CONFERENCE DATE 2010-05-25 to 2010-05-29 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT OBJECTIVES: Women who carry a BRCA1/2 mutation are presented with surgical options to reduce their risk of breast and ovarian cancer, including risk-reducing mastectomy (RRM) and oophorectomy (RRO). Growing evidence suggests a sub-group of women do not make decisions about RRM and RRO immediately following genetic testing, but rather, consider these decisions years later. The purpose of this research was to describe how women construct the 'right time' to consider decisions about RRM and RRO. METHOD: In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. RESULTS: The women constructed the 'right time' to consider these decisions to be when: (1) decisions fit into their lives, (2) they had enough time to think about decisions, (3) they were ready emotionally to deal with the decisions and the consequences, (4) all the issues and conflicts were sorted out, (5) there were better options available, and (6) the health care system was ready for them. CONCLUSIONS: These findings offer novel insights relevant to health care professionals who provide decision support to women considering hereditary breast and ovarian cancer risk-reducing surgeries. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female mastectomy oncology ovariectomy risk EMTREE MEDICAL INDEX TERMS breast cancer risk constant comparative method decision support system genetic screening health care personnel health care system interview mutation ovary cancer surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70184407 DOI 10.1002/pon.1776 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1776 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 381 TITLE Preserving the self: The process of decision making about hereditary breast and ovarian cancer risk-reduction AUTHOR NAMES Howard A.F. Balneaves L.G. Bottorff J.L. Rodney P. AUTHOR ADDRESSES (Howard A.F.; Balneaves L.G.; Rodney P.) University of British Columbia, Vancouver, Canada. (Bottorff J.L.) University of British Columbia Okanagan, Kelowna, Canada. CORRESPONDENCE ADDRESS A.F. Howard, University of British Columbia, Vancouver, Canada. SOURCE Psycho-Oncology (2010) 19 SUPPL. 2 (S70-S71). Date of Publication: May 2010 CONFERENCE NAME IPOS 12th World Congress of Psycho-Oncology CONFERENCE LOCATION Quebec City, QC, Canada CONFERENCE DATE 2010-05-25 to 2010-05-29 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT OBJECTIVES: Women who carry a BRCA1 or BRCA2 gene mutation have up to an 88% lifetime risk of breast cancer and up to a 65% lifetime risk of ovarian cancer. Strategies to address these risks include cancer screening and risk-reducing surgery (i.e. mastectomy and salpin-go-oophorectomy). METHOD: A grounded theory study with 22 BRCA1/2 mutation carrier women was conducted to understand how women make decisions about these risk-reducing strategies. RESULTS: The process of preserving the self was the overarching decision-making process evident in the participants' descriptions. This process was shaped by contextual conditions including the characteristics of health services, the nature of hereditary breast and ovarian cancer risk-reduction decisions, gendered roles, and the women's perceived proximity to cancer. The women engaged in five decision-making styles and these were characterized by the use of specific cognitive and emotional decision-making approaches. CONCLUSIONS: These findings provide theoretical insights that could inform the provision of decisional support to BRCA1/2 carriers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer risk decision making oncology ovary cancer risk reduction EMTREE MEDICAL INDEX TERMS breast cancer cancer screening female gene mutation grounded theory health service lifespan mastectomy mutation neoplasm ovariectomy risk surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70184408 DOI 10.1002/pon.1776 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1776 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 382 TITLE Physicians' awareness and attitudes toward decision aids for patients with cancer AUTHOR NAMES Brace C. Schmocker S. Huang H. Victor J.C. McLeod R.S. Kennedy E.D. AUTHOR ADDRESSES (Brace C.; Schmocker S.; Huang H.; Victor J.C.; McLeod R.S.; Kennedy E.D., erin.kennedy@uhn.on.ca) CORRESPONDENCE ADDRESS E. D. Kennedy, Department of Surgery, 10EN-216 Toronto General Hospital, 200 Elizabeth St, Toronto, ON M5G 2C4, United States. Email: erin.kennedy@uhn.on.ca SOURCE Journal of Clinical Oncology (2010) 28:13 (2286-2292). Date of Publication: 1 May 2010 ISSN 0732-183X 1527-7755 (electronic) BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Patient decision aids are interventions designed to help patients make deliberative choices about their treatment options and have been shown to significantly improve patient outcomes. Although considered optimal, decision aids are not widely used in clinical practice for cancer treatment. The objectives of this study are to determine physicians' awareness and use of decision aids, physicians' perceptions of the major barriers to the use of decision aids, and physician characteristics predictive of use of decision aids in clinical practice. Methods: A population-based survey was mailed to general surgeons, medical oncologists, and radiation oncologists. Results: The survey was mailed to 878 physicians, and the overall response rate to the survey was 64.5%. The majority of the participants were male and working in community hospitals for more than 10 years. Overall, 69% of the respondents were aware of decision aids, and 46% were aware of decision aids relevant to their practice. However, only 24% were currently using decision aids. The main barriers to the use of decision aids were reported as lack of awareness, lack of resources, and lack of time. Multivariate analysis showed specialty to be the only physician characteristic influencing the use of decision aids. Conclusion: Approximately one third of physicians treating cancer patients are not aware of what decision aids are, and only 24% are currently using decision aids in clinical practice. Strategies to increase physician awareness about decision aids and to implement these tools into clinical practice are important. © 2010 by American Society of Clinical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient medical decision making physician attitude EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article human mastectomy medical specialist oncologist priority journal prostatectomy questionnaire shared decision making surgeon EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011102026 MEDLINE PMID 20354133 (http://www.ncbi.nlm.nih.gov/pubmed/20354133) PUI L361292112 DOI 10.1200/JCO.2009.25.2874 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2009.25.2874 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 383 TITLE Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: Uptake and timing AUTHOR NAMES Skytte A.-B. Gerdes A.-M. Andersen M.K. Sunde L. Brøndum-Nielsen K. Waldstrøm M. Kølvraa S. Crüger D. AUTHOR ADDRESSES (Skytte A.-B., anne-bine.skytte@slb.regionsyddanmark.dk; Kølvraa S.; Crüger D.) Department of Clinical Genetics, Vejle Hospital, Vejle, Denmark. (Gerdes A.-M.) Department of Clinical Genetics, Odense University Hospital, Odense, Denmark. (Andersen M.K.) Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark. (Sunde L.) Department of Clinical Genetics Aarhus University Hospital, Aarhus, Denmark. (Brøndum-Nielsen K.) Department of Clinical Genetics, Kennedy Centre, Glostrup, Denmark. (Waldstrøm M.) Department of Pathology, Vejle Hospital, Vejle, Denmark. CORRESPONDENCE ADDRESS A.-B. Skytte, Lillebaelt Hospital, Department of Clinical Genetics, Kabbeltoft 25, 7100 Vejle, Denmark. Email: anne-bine.skytte@slb.regionsyddanmark.dk SOURCE Clinical Genetics (2010) 77:4 (342-349). Date of Publication: April 2010 ISSN 0009-9163 1399-0004 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Once female carriers of a BRCA mutation are identified they have to make decisions on risk management. The aim of this study is to outline the uptake of risk-reducing surgery in the Danish population of BRCA mutation positive women and to search for factors affecting this decision. We analysed data from 306 healthy BRCA carriers with no personal history of ovarian or breast cancer. We found a 10-year uptake of 75% for risk-reducing salpingo-oophorectomy and 50% for risk-reducing mastectomy by time to event analysis. Age and childbirth influenced this decision. The uptake rate has not changed significantly over the last decade. Risk-reducing surgeries are widely acceptable among Danish BRCA mutation positive women and the uptake of prophylactic mastectomy is higher than in most other countries. © 2010 John Wiley & Sons A/S. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gene mutation mastectomy salpingooophorectomy EMTREE MEDICAL INDEX TERMS adult age aged article breast cancer (prevention) cancer prevention childbirth controlled study Denmark female genetic counseling human major clinical study mutational analysis ovary cancer (prevention) priority journal risk reduction EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010257441 MEDLINE PMID 20059483 (http://www.ncbi.nlm.nih.gov/pubmed/20059483) PUI L358745302 DOI 10.1111/j.1399-0004.2009.01329.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1399-0004.2009.01329.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 384 TITLE Sociodemographics, referral patterns, and Internet use for decision-making in microsurgical breast reconstruction. AUTHOR NAMES Matros E. Yueh J.H. Bar-Meir E.D. Slavin S.A. Tobias A.M. Lee B.T. AUTHOR ADDRESSES (Matros E.; Yueh J.H.; Bar-Meir E.D.; Slavin S.A.; Tobias A.M.; Lee B.T.) Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. 02215, USA. CORRESPONDENCE ADDRESS E. Matros, Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. 02215, USA. SOURCE Plastic and reconstructive surgery (2010) 125:4 (1087-1094). Date of Publication: Apr 2010 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Increasing numbers of patients are choosing to undergo microsurgical breast reconstruction. Currently, no information is available about the sociodemographic profile, referral patterns, or decision-making process of women who choose this reconstructive modality. METHODS: All women who underwent breast reconstruction at a single institution between 2004 and 2007 were surveyed regarding demographic information, referral patterns, and decision-making processes. For data analysis, the cohort was separated by reconstructive method: nonmicrosurgical reconstruction (i.e., implant, latissimus, and pedicled transverse rectus abdominis musculocutaneous flaps) or microsurgical reconstruction (i.e., free transverse rectus abdominis musculocutaneous, deep inferior epigastric artery perforator, superficial inferior epigastric artery, and superior gluteal artery perforator flaps). RESULTS: Overall, 332 women were surveyed, with a response rate of 77 percent. Patients who underwent microsurgical reconstruction were more likely to be 40 to 49 years old (p = 0.014), whereas nonmicrosurgical patients were clustered at the extremes of age. Microsurgery patients self-referred to a reconstructive surgeon, whereas other patients were sent by surgical oncologists (p < 0.001). The Internet was an important decision-making aid to help microsurgery patients identify their reconstructive modality (p < 0.001). Compared with nonmicrosurgical counterparts, microsurgery patients were independent decision-makers and more active in choosing their reconstructive procedure (p = 0.001). CONCLUSIONS: Microsurgical breast reconstruction is highly sought after by a subset of patients with breast cancer. These patients are independent decision-makers in their health care choices. They use the Internet to learn about breast reconstruction techniques and are more likely to self-refer to a reconstructive surgeon. It remains unclear how many patients would choose microsurgical reconstruction if offered more widely or if awareness of the procedure were greater. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (epidemiology, surgery) Internet microsurgery patient referral EMTREE MEDICAL INDEX TERMS adult article breast endoprosthesis decision making demography female health care survey health education human mastectomy methodology middle aged patient attitude plastic surgery questionnaire retrospective study standard statistics LANGUAGE OF ARTICLE English MEDLINE PMID 20072087 (http://www.ncbi.nlm.nih.gov/pubmed/20072087) PUI L358679542 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 385 TITLE Computer-based learning module increases shared decision making in breast reconstruction AUTHOR NAMES Lee B.T. Chen C. Yueh J.H. Nguyen M.-D. Lin S.J. Tobias A.M. AUTHOR ADDRESSES (Lee B.T., blee3@bidmc.harvard.edu; Chen C.; Yueh J.H.; Nguyen M.-D.; Lin S.J.; Tobias A.M.) Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS B. T. Lee, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States. Email: blee3@bidmc.harvard.edu SOURCE Annals of Surgical Oncology (2010) 17:3 (738-743). Date of Publication: March 2010 ISSN 1068-9265 1534-4681 (electronic) BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT Background: Shared decision making (SDM) combines evidence-based medicine with individual patient preferences. Patients who are actively engaged in their own health care management with their physicians have been shown to experience not only increased compliance, but also higher satisfaction and better outcomes. We hypothesize that a computer-based learning module for breast reconstruction increases patient involvement in the decision-making process. Materials and Methods: Women who underwent either immediate or delayed breast reconstruction at an academic teaching hospital from 2004 to 2007 were identified. Patients meeting inclusion criteria were mailed questionnaires on demographics, informational resources, and decision-making processes. Questionnaire results were divided into 2 groups for analysis: patients who received a standard surgeon consultation and patients who were shown a computer-based decision aid in addition to the standard consultation. Results: There were 358 women eligible for our study. A total of 255 patients (75.9%) responded to the survey; 168 patients were shown the computer-based decision aid and 87 patients were not. Patients who used the computer-based learning module reported a greater role in choosing the type of reconstruction (P < .001). Additionally, these patients reported a greater number of reconstructive options offered to them (P < .001) and were more satisfied with the amount of information provided by their reconstructive surgeon (P = .049). Conclusions: A computer-based learning module allows patients to assimilate information and actively participate in choosing type of breast reconstruction. Use of this educational modality represents a simple and effective way to improve the shared decision-making process. © 2009 Society of Surgical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction clinical decision making computer aided design learning EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) cancer surgery consultation demography female health survey human major clinical study outcome assessment structured questionnaire surgeon EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010125176 MEDLINE PMID 20039216 (http://www.ncbi.nlm.nih.gov/pubmed/20039216) PUI L50748311 DOI 10.1245/s10434-009-0869-7 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-009-0869-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 386 TITLE A novel support tool for breast multidisciplinary meetings: An advanced evidence based computer decision support technology AUTHOR NAMES Patkar V. Acosta D. Fox J. Jones A. Davidson T. Keshtgar M. AUTHOR ADDRESSES (Patkar V.; Acosta D.; Keshtgar M.) UCL, Cancer Institute, London, United Kingdom. (Fox J.) Oxford University, Engineering Science, Oxford, United Kingdom. (Jones A.) Royal Free Hospital, Oncology, London, United Kingdom. (Davidson T.) Royal Free Hospital, Breast Surgery, London, United Kingdom. CORRESPONDENCE ADDRESS V. Patkar, UCL, Cancer Institute, London, United Kingdom. SOURCE European Journal of Cancer, Supplement (2010) 8:3 (211). Date of Publication: March 2010 CONFERENCE NAME European Breast Cancer Conference, EBCC7 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2010-03-24 to 2010-03-27 ISSN 1359-6349 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Breast multidisciplinary meetings (MDMs) provide the key forum where all important patient management decisions are taken. MDMs are widely accepted in many countries as the standard of care however there is an urgent need for better tools for supporting andmonitoring these heavily loaded meetings to maximize their efficacy. Advanced computerised decision support (CDS) technology could offer many of these services to actively support busy MDMs. We present a novel breast MDM support tool which integrates a CDS system into an electronic patient record to assist breast multi disciplinary team in making evidence based, transparent treatment decisions. Methods: The Multi-disciplinary meeting Assistant and Treatment sElector (MATE) is a tool designed to assist breast clinicians in making management decisions for their patients in MDM. MATE uses logic based computational framework to provide a clinical guideline-based decision support system for breast cancer MDM. MATE evaluates patient's clinical facts and suggests optimal management options according to incorporated national and international clinical guidelines. The evidence base used in MATE can be updated as and when new evidence is published. MATE recommendations are not binding and the final decision is taken by respective breast Multidisciplinary MATE facilitates the flexible conduct of MDM. Additionally, it highlights if the patient is eligible to take part in any local, national or international clinical trials. MATE is implemented in the breast unit of Royal Free hospital, London for its pilot testing. In the evaluation study, the data of 500 consecutive breast patients presented at our MDM along with their documented MDM recommendations are entered in MATE. MDM recommendations and MATE suggestions are analysed. Results: MATEsystem is able to suggest the treatment recommendations in concordance with breast MDT in majority of the cases (89%). MATE also identified 60% more patients suitable for ongoing clinical trials. Deviations that occur specially in unaided MDMs can be minimised using electronic data capture and decision support system like MATE. MATE also significantly improved the transparency and the documentation of MDM outcomes. Conclusion: This evaluation study has shown the feasibility of implementing MATE into MDM and its potential to improve certain aspects of MDM by helping overburdened clinicians. Further evaluations of MATE in a randomised controlled trial are under way. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer computer decision support system evidence based practice technology EMTREE MEDICAL INDEX TERMS clinical trial documentation evaluation study hospital medical record patient patient care randomized controlled trial United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70122564 DOI 10.1016/S1359-6349(10)70539-5 FULL TEXT LINK http://dx.doi.org/10.1016/S1359-6349(10)70539-5 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 387 TITLE Impact of the cost of cancer treatment: An internet-based survey AUTHOR NAMES Markman M. Luce R. AUTHOR ADDRESSES (Markman M., mmarkman@mdanderson.org) University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States. (Luce R.) NexCura, Seattle, WA, United States. CORRESPONDENCE ADDRESS M. Markman, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States. Email: mmarkman@mdanderson.org SOURCE Journal of Oncology Practice (2010) 6:2 (69-73). Date of Publication: March 2010 ISSN 1554-7477 1935-469X (electronic) BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Despite considerable discussion in the medical literature and lay press regarding the increasing cost of cancer care, there is limited information available on the perceived impact of treatment costs on individual patients and their families. Methods: To directly address this issue, patients with cancer who had participated in an Internet-based oncology decision-support program and agreed to receive information concerning potential future surveys were asked via e-mail to complete a questionnaire dealing with treatment-related medical expenses. Results: Of 39,882 invitations sent to patients with cancers of the breast, colon, lung, and prostate, 1,767 (4.4%) were returned, which included a wide spectrum of disease, demographics, and annual incomes. Since diagnosis, 20% and 4% of patients reported having spent out of pocket more than $10,000 and more than $50,000, respectively, on treatment and medical care. Overall, 19% of patients and 39% of individuals with a yearly income of less than $40,000 reported the financial costs of treating their cancer had caused a "large amount of distress." Furthermore, although overall, 9% of patients stated they had decided "to not have a recommended cancer treatment because it was too expensive," this percentage increased to 25% for individuals with an income of less than $40,000. Conclusion: This survey suggests that a substantial proportion of patients and their families experience considerable distress associated with the cost of cancer care delivery. Furthermore, these costs affect the decision of patients with cancer to receive recommended treatment. This is a particularly serious issue for individuals with a modest annual income. Copyright © 2010 by American Society of Clinical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer therapy health care cost neoplasm (disease management) EMTREE MEDICAL INDEX TERMS article breast cancer (disease management) cancer diagnosis cancer patient cancer staging colon cancer (disease management) decision support system demography distress syndrome e-mail family financial management health care delivery health survey human income Internet lung cancer (disease management) medical care medical literature oncology prostate prostate cancer (disease management) questionnaire spectrum EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010497470 PUI L359518541 DOI 10.1200/JOP.091074 FULL TEXT LINK http://dx.doi.org/10.1200/JOP.091074 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 388 TITLE Patient factors in the implementation of decision aids in general practice: a qualitative study. AUTHOR NAMES Bhavnani V. Fisher B. AUTHOR ADDRESSES (Bhavnani V.) Honorary Research Associate, Department of General Practice and Primary Care, Kings College London, London, UK. (Fisher B.) CORRESPONDENCE ADDRESS V. Bhavnani, Honorary Research Associate, Department of General Practice and Primary Care, Kings College London, London, UK. SOURCE Health expectations : an international journal of public participation in health care and health policy (2010) 13:1 (45-54). Date of Publication: Mar 2010 ISSN 1369-7625 (electronic) ABSTRACT BACKGROUND: Decision aids (DAs) have been developed to help patients make treatment decisions. Research shows that they are effective in increasing patients' knowledge of treatment options without raising anxiety or conflict. However, they have not been routinely adopted for use in general practice in the UK and there are few reports addressing strategies to introduce them. OBJECTIVE: To examine patients' views about a variety of DAs for different conditions (heart disease, osteoporosis, osteoarthritis and breast cancer) in order to inform a strategy to introduce them into general practice. SETTING AND PARTICIPANTS: General practice patients over the age of 18 years being or having been treated for one of the conditions above. METHODS: Qualitative study involving 12 focus groups with 77 patients evaluating decision aids relevant to their conditions. A semi-structured interview guide was used to generate discussions about the applicability of the DAs in routine general practice. RESULTS: Patients welcomed DAs for their educational and informational content. Reactions to the DAs were influenced by patients' own personal desires for involvement. The main concerns were that the use of DAs would potentially shift the onus of decision making responsibility on to the patient and about the practical challenges to implementation. CONCLUSIONS: Clinicians will need to make explicit to patients that DAs are an adjunct to routine care and not a replacement, and therefore do not represent a derogation of responsibility. DAs need to be used as an integral part of the communication and support process for patients who want them. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system general practice patient participation EMTREE MEDICAL INDEX TERMS adult aged article female human information processing male middle aged United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 19811545 (http://www.ncbi.nlm.nih.gov/pubmed/19811545) PUI L359297185 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 389 TITLE Attitudes of Canadian Radiation Oncologists towards Post-lumpectomy Radiotherapy for Elderly Women with Stage I Hormone-responsive Breast Cancer AUTHOR NAMES Warner E. Chow E. Fairchild A. Franssen E. Paszat L. Szumacher E. AUTHOR ADDRESSES (Warner E.; Chow E.; Franssen E.; Paszat L.; Szumacher E., ewa.szumacher@sunnybrook.ca) Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ont., Canada. (Fairchild A.; Franssen E.) Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta., Canada. (Franssen E.) Faculty of Medicine, University of Toronto, Canada. CORRESPONDENCE ADDRESS E. Szumacher, Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ont., Canada. Email: ewa.szumacher@sunnybrook.ca SOURCE Clinical Oncology (2010) 22:2 (97-106). Date of Publication: March 2010 ISSN 0936-6555 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Aims: Post-lumpectomy breast radiation is the standard of care for all patient subgroups. However, elderly women with stage I breast cancer on adjuvant tamoxifen therapy have a 4% risk of local recurrence after lumpectomy without adjuvant breast radiation. The purpose of this study was to explore the attitudes of Canadian radiation oncologists who treat breast cancer with respect to their use of adjuvant post-lumpectomy radiotherapy, and their willingness to implement a decision aid for this patient population. Materials and methods: The questionnaire was mailed to 141 Canadian radiation oncologists who treat breast cancer. The respondents were asked to complete an online survey consisting of four parts: (1) demographic information; (2) factors determining post-lumpectomy radiation treatment decisions; (3) hypothetical case scenarios; (4) interest in using a decision aid in their practice. Results: Among the 61 (43%) physicians who completed the survey, there was substantial response variation. After contraindications to radiotherapy, patient overall health and patient preference had the greatest influence on their decision to offer radiotherapy to this patient subgroup. Margin status and use of hormonal therapy were given less importance. For each of the case scenarios, 60-83% of physicians (depending on the case scenario) would offer the patient a choice; far fewer (12-57%) would be comfortable not irradiating. Sixty-four per cent of respondents welcomed the concept of a decision aid for this population. Conclusions: Although there is significant variation in practice patterns and attitudes among radiation oncologists regarding post-lumpectomy radiotherapy for elderly, low-risk breast cancer patients, the vast majority value patient choice and would be willing to use a decision aid designed for this population in their practice. © 2009 The Royal College of Radiologists. EMTREE DRUG INDEX TERMS antiestrogen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy) cancer radiotherapy partial mastectomy physician attitude EMTREE MEDICAL INDEX TERMS adult article Canada cancer adjuvant therapy cancer hormone therapy cancer staging clinical practice controlled study demography elderly care female health status health survey human male medical decision making online system priority journal questionnaire treatment contraindication EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010070935 MEDLINE PMID 19883996 (http://www.ncbi.nlm.nih.gov/pubmed/19883996) PUI L50689532 DOI 10.1016/j.clon.2009.10.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.clon.2009.10.001 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 390 TITLE Shared decision making coding systems: How do they compare in the oncology context? AUTHOR NAMES Butow P. Juraskova I. Chang S. Lopez A.-L. Brown R. Bernhard J. AUTHOR ADDRESSES (Butow P., phyllisb@psych.usyd.edu.au; Juraskova I.; Chang S.; Lopez A.-L.) Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Australia. (Brown R.) Department of Psychiatry, Behavioral Sciences Memorial Sloan-Kettering Cancer Center, Weill Medical College, NY, United States. (Bernhard J.) IBCSG Coordinating Center, Bern, Switzerland. (Bernhard J.) Inselspital, Bern University Hospital, Department of Medical Oncology, Bern, Switzerland. CORRESPONDENCE ADDRESS P. Butow, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Australia. Email: phyllisb@psych.usyd.edu.au SOURCE Patient Education and Counseling (2010) 78:2 (261-268). Date of Publication: February 2010 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: The current study aimed to evaluate three coding systems which have been used to assess shared decision making in oncology consultations (OPTION, Decision Support Analysis Tool (DSAT) and Decision Analysis System for Oncology (DAS-O)): (i) comparing their ability to identify competencies of shared decision making, and (ii) determining their ability to predict patient outcomes in a single data set. Method: Twenty oncologists from Australia and New Zealand participated in the IBCSG Trial 33-03. The consultations of 55 women with early stage breast cancer were audio-taped, transcribed and then coded using the OPTION, DAS-O and DSAT coding systems by three different raters. Women completed the questionnaires 2 weeks and 4 months after their consultation. Results: DAS-O was strongly correlated with OPTION (r = 0.73). DSAT was moderately correlated with DAS-O and OPTION (r < 0.6). Decisional satisfaction and satisfaction with doctor SDM skills were significantly correlated with OPTION (r = 0.39 and 0.42 respectively) and the latter variable was correlated with DAS-O (r = 0.40). These relationships persisted in multiple linear regression analyses. Conclusions: OPTION may be the most efficient and sensitive coding system for research purposes; however, DSAT appeared to document behaviours reducing decisional conflict and both DSAT and DAS-O offer more detailed feedback to doctors. Practice implications: Optimal coding system will depend on research goals and training purposes. © 2009 Elsevier Ireland Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) doctor patient relation medical decision making oncology EMTREE MEDICAL INDEX TERMS adult article breast cancer coding consultation female health care management human major clinical study patient attitude priority journal professional competence EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010032974 MEDLINE PMID 19647966 (http://www.ncbi.nlm.nih.gov/pubmed/19647966) PUI L50598505 DOI 10.1016/j.pec.2009.06.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2009.06.009 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 391 TITLE Pre-operative MRI for women with newly diagnosed breast cancer: Perspectives on clinician and patient decision-making when evidence is uncertain AUTHOR NAMES McCaffery K.J. Jansen J. AUTHOR ADDRESSES (McCaffery K.J., kirstenm@health.usyd.edu.au; Jansen J.) Screening and Test Evaluation Program, School of Public Health, University of Sydney, Edward Ford Building, A27, NSW 2006, Australia. CORRESPONDENCE ADDRESS K.J. McCaffery, Screening and Test Evaluation Program, School of Public Health, University of Sydney, Edward Ford Building, A27, NSW 2006, Australia. Email: kirstenm@health.usyd.edu.au SOURCE Breast (2010) 19:1 (10-12). Date of Publication: February 2010 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT The routine use of pre-operative MRI in women with newly diagnosed breast cancer highlights the complexities of the use of new technology when evidence of benefit is uncertain. There are both potential harms and benefits. In the short term patients may desire and feel reassured by further testing and the use of new diagnostic techniques. However, they may also experience greater anxiety and distress from further tests and related follow-up procedures such as biopsy. In the long term MRI may result in more radical treatment decisions which are associated with poorer quality of life for women. Both patients and clinicians often (wrongly) assume that more information via testing leads to better outcomes (information bias). So how should pre-operative MRI be integrated into breast cancer care? First women need to be made aware of the uncertain evidence surrounding MRI. However whether it is appropriate to burden women with complex information and yet another decision at a time of high vulnerability and emotional distress should be considered. One potential solution is to use a Community Informed Consent approach in which a representative sample of patients and healthy women are educated about the benefits and harms and give their informed opinion about whether pre-operative MRI should be offered. Another approach is to provide patients with an evidence based decision aid to support individual informed choice. Either or a combination of both approaches would be acceptable and should be investigated. At present women are poorly informed about pre operative MRI and it is likely that they assume outcomes are be improved as a result. Clear communication about the limits of MRI to patients is needed alongside randomised trials to provide the evidence that benefit indeed outweighs the harms so that all parties involved may be comprehensively informed. © 2009 Elsevier Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) nuclear magnetic resonance imaging patient decision making preoperative evaluation EMTREE MEDICAL INDEX TERMS article cancer diagnosis clinical decision making emotional stress health care quality human informed consent medical information patient attitude patient education patient guidance priority journal prognosis quality of life EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010274550 MEDLINE PMID 20159458 (http://www.ncbi.nlm.nih.gov/pubmed/20159458) PUI L358804201 DOI 10.1016/j.breast.2009.11.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2009.11.005 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 392 TITLE Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers AUTHOR NAMES Kurian A.W. Sigal B.M. Plevritis S.K. AUTHOR ADDRESSES (Kurian A.W.; Sigal B.M.; Plevritis S.K., sylvia.plevritis@stanford.edu) Department of Radiology, Stanford University, School of Medicine, Stanford, CA 94305, United States. CORRESPONDENCE ADDRESS S. K. Plevritis, Department of Radiology, Stanford University, School of Medicine, Stanford, CA 94305, United States. Email: sylvia.plevritis@stanford.edu SOURCE Journal of Clinical Oncology (2010) 28:2 (222-231). Date of Publication: 10 Jan 2010 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Women with BRCA1/2 mutations inherit high risks of breast and ovarian cancer; options to reduce cancer mortality include prophylactic surgery or breast screening, but their efficacy has never been empirically compared. We used decision analysis to simulate risk-reducing strategies in BRCA1/2 mutation carriers and to compare resulting survival probability and causes of death. Methods: We developed a Monte Carlo model of breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years, prophylactic mastectomy (PM) at various ages, and/or prophylactic oophorectomy (PO) at ages 40 or 50 years in 25-year-old BRCA1/2 mutation carriers. Results: With no intervention, survival probability by age 70 is 53% for BRCA1 and 71% for BRCA2 mutation carriers. The most effective single intervention for BRCA1 mutation carriers is PO at age 40, yielding a 15% absolute survival gain; for BRCA2 mutation carriers, the most effective single intervention is PM, yielding a 7% survival gain if performed at age 40 years. The combination of PM and PO at age 40 improves survival more than any single intervention, yielding 24% survival gain for BRCA1 and 11% for BRCA2 mutation carriers. PM at age 25 instead of age 40 offers minimal incremental benefit (1% to 2%); substituting screening for PM yields a similarly minimal decrement in survival (2% to 3%). Conclusion: Although PM at age 25 plus PO at age 40 years maximizes survival probability, substituting mammography plus MRI screening for PM seems to offer comparable survival. These results may guide women with BRCA1/2 mutations in their choices between prophylactic surgery and breast screening. © 2009 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein BRCA2 protein EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer mortality cancer risk cancer survival gene mutation risk reduction EMTREE MEDICAL INDEX TERMS adult aged article cancer screening controlled study female heterozygote human major clinical study mammography mastectomy Monte Carlo method nuclear magnetic resonance imaging ovariectomy ovary cancer priority journal sensitivity analysis EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010193887 MEDLINE PMID 19996031 (http://www.ncbi.nlm.nih.gov/pubmed/19996031) PUI L358535513 DOI 10.1200/JCO.2009.22.7991 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2009.22.7991 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 393 TITLE Development of decision-support intervention for Black women with breast cancer AUTHOR NAMES Sheppard V.B. Williams K.P. Harrison T.M. Jennings Y. Lucas W. Stephen J. Robinson D. Mandelblatt J.S. Taylor K.L. AUTHOR ADDRESSES (Sheppard V.B., vls3@georgetown.edu; Harrison T.M.; Jennings Y.; Lucas W.; Mandelblatt J.S.; Taylor K.L.) Georgetown University, Cancer Control Program, 3300 Whitehaven Street, NW, Washington, DC 20007, United States. (Williams K.P.) Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, East Lansing, MI, United States. (Stephen J.) Department of Health Promotion, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States. (Robinson D.) Sisters from the Heart, Washington, DC, United States. (Robinson D.) Sisters from the Heart, Suitland, MD, United States. CORRESPONDENCE ADDRESS V. B. Sheppard, Georgetown University, Cancer Control Program, 3300 Whitehaven Street, NW, Washington, DC 20007, United States. Email: vls3@georgetown.edu SOURCE Psycho-Oncology (2010) 19:1 (62-70). Date of Publication: January 2010 ISSN 1057-9249 1099-1611 (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Background: Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women. Methods: Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors. Results: Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer. Conclusion: Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment. Copyright © 2009 John Wiley & Sons Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision making support group EMTREE MEDICAL INDEX TERMS adjuvant therapy adult African American aged article cancer survival communication skill community care controlled study coping behavior female groups by age human interview personal experience spiritual care training EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010074874 MEDLINE PMID 19267384 (http://www.ncbi.nlm.nih.gov/pubmed/19267384) PUI L358199152 DOI 10.1002/pon.1530 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1530 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 394 TITLE The carrier clinic: An evaluation of a novel clinic dedicated to the follow-up of BRCA1 and BRCA2 carriers - Implications for oncogenetics practice AUTHOR NAMES Bancroft E.K. Locke I. Ardern-Jones A. D'Mello L. McReynolds K. Lennard F. Barbachano Y. Barwell J. Walker L. Mitchell G. Dorkins H. Cummings C. Paterson J. Kote-Jarai Z. Mitra A. Jhavar S. Thomas S. Houlston R. Shanley S. Eeles R.A. AUTHOR ADDRESSES (Bancroft E.K.; Locke I.; Ardern-Jones A.; McReynolds K.; Barbachano Y.; Barwell J.; Walker L.; Mitchell G.; Thomas S.; Houlston R.; Shanley S.; Eeles R.A., rosalind.eeles@icr.ac.uk) Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. (Bancroft E.K.; Locke I.; D'Mello L.; Lennard F.; Kote-Jarai Z.; Mitra A.; Jhavar S.; Houlston R.; Eeles R.A., rosalind.eeles@icr.ac.uk) Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, United Kingdom. (Dorkins H.; Cummings C.) Kennedy Galton Centre, Northwick Park and St. Marks NHS Trust, Watford Road, Harrow, Middlesex, United Kingdom. (Paterson J.) Addenbrooke's Hospital, Cambridge, United Kingdom. CORRESPONDENCE ADDRESS R. A. Eeles, Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, United Kingdom. Email: rosalind.eeles@icr.ac.uk SOURCE Journal of Medical Genetics (2010) 47:7 (486-491). Date of Publication: July 2010 ISSN 1468-6244 (electronic) 0022-2593 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background: A novel oncogenetic clinic was established in 2002 at the Royal Marsden NHS Foundation Trust offering advice and specialist follow-up for families with a germline mutation in BRCA1 or BRCA2. The remit of this multidisciplinary clinic, staffed by individuals in both oncology and genetics, is to provide individualised screening recommendations, support in decision making, risk reducing strategies, cascade testing, and an extensive research portfolio. Methods: A retrospective analysis was performed to evaluate uptake of genetic testing, risk reducing surgery and cancer prevalence in 346 BRCA1/BRCA2 families seen between January 1996 and December 2006. Results: 661 individuals attended the clinic and 406 mutation carriers were identified; 85.8% mutation carriers have chosen to attend for annual follow-up. 70% of mutation carriers elected for risk reducing bilateral salpingo-oophorectomy (RRBSO). 32% of unaffected women chose risk reducing bilateral mastectomy. 32% of women with breast cancer chose contralateral risk reducing mastectomy at time of diagnosis. Some women took over 8 years to decide to have surgery. 91% of individuals approached agreed to participate in research programmes. Interpretation: A novel specialist clinic for BRCA1/2 mutation carriers has been successfully established. The number of mutation positive families is increasing. This, and the high demand for RRBSO in women over 40, is inevitably going to place an increasing demand on existing health resources. Our clinic model has subsequently been adopted in other centres and this will greatly facilitate translational studies and provide a healthcare structure for management and follow-up of such people who are at a high cancer risk. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 associated ring domain protein 1 (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heterozygote EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (surgery) cancer risk clinical practice family study female follow up gene mutation genetic screening human major clinical study male mastectomy prevalence priority journal retrospective study salpingooophorectomy EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010467604 MEDLINE PMID 20472659 (http://www.ncbi.nlm.nih.gov/pubmed/20472659) PUI L359440375 DOI 10.1136/jmg.2009.072728 FULL TEXT LINK http://dx.doi.org/10.1136/jmg.2009.072728 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 395 TITLE Satisfaction with care among low-income women with breast cancer AUTHOR NAMES Thind A. Hoq L. Diamant A. Maly R.C. AUTHOR ADDRESSES (Thind A., athind2@uwo.ca) Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada. (Hoq L.) Cedars-Sinai Medical Center, Los Angeles, CA, United States. (Diamant A.) Department of General Internal Medicine, University of California, Los Angeles, CA, United States. (Maly R.C.) Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS A. Thind, Department of Family Medicine, Department of Epidemiology and Biostatistics, 245-100 Collip Circle, London, ON N6G 4X8, Canada. Email: athind2@uwo.ca SOURCE Journal of Women's Health (2010) 19:1 (77-85). Date of Publication: 1 Jan 2010 ISSN 1540-9996 BOOK PUBLISHER Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States. ABSTRACT Background: Patient satisfaction is an important outcome measure in determining quality of care. There are few data evaluating patient satisfaction in nonwhite, low-income populations. The objective of this study was to identify the structure, process, and outcome factors that impact patient satisfaction with care in a low-income population of women with breast cancer. Methods: In a cross-sectional survey of low-income women newly diagnosed with breast cancer, eligible women enrolled in the California Breast and Cervical Cancer Treatment Program (BCCTP) from February 2003 through September 2005 were interviewed by phone 6 months after their enrollment. This was a population-based sample of women aged ≥18 years (n=924) with a definitive diagnosis of breast cancer and enrolled in the BCCTP. The main outcome measure was satisfaction with care received. Results: Random effects logistic regression revealed that less acculturated Latinas were more likely (odds ratio, [OR]=5.36, p<0.000) to be extremely satisfied with their care compared with non-Hispanic white women. Women who believed they could have been diagnosed sooner were less likely to be extremely satisfied (OR=0.61, p<0.000). Women who had received or were receiving radiotherapy or chemotherapy had nearly twice the odds of being extremely satisfied (OR=2.02, p<0.000, and OR=2.13, p<0.000, respectively). Greater information giving was associated with greater satisfaction (OR=1.17, p<0.000). Women reporting greater physician emotional support were more likely to report being extremely satisfied (OR=1.26, p<0.000). A higher participatory treatment decision-making score was associated with greater satisfaction (OR=1.78, p<0.000). Conclusions: In a low-income population, satisfaction is also reported at high levels. In addition to age, ethnicity/acculturation, receipt of chemotherapy and radiotherapy, physician emotional support, and collaborative decision making, perception of diagnostic delay is a predictor of dissatisfaction in this population. Copyright 2010, Mary Ann Liebert, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management) patient satisfaction EMTREE MEDICAL INDEX TERMS adult article emotion female health care quality health personnel attitude human lowest income group major clinical study medical decision making outcome assessment priority journal self concept EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010081150 MEDLINE PMID 20088662 (http://www.ncbi.nlm.nih.gov/pubmed/20088662) PUI L358219745 DOI 10.1089/jwh.2009.1410 FULL TEXT LINK http://dx.doi.org/10.1089/jwh.2009.1410 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 396 TITLE Ashley revisited: A response to the critics AUTHOR NAMES Diekema D.S. Fost N. AUTHOR ADDRESSES (Diekema D.S., diek@u.washington.edu) University of Washington School of Medicine, Treuman Katz Center for Pediatric Bioethics, MPW 8-2, 1100 Olive Way, Suite 500, Seattle, WA 98101, United States. (Fost N.) University of Wisconsin School of Medicine and Public Health, United States. CORRESPONDENCE ADDRESS D. S. Diekema, University of Washington School of Medicine, Treuman Katz Center for Pediatric Bioethics, MPW 8-2, 1100 Olive Way, Suite 500, Seattle, WA 98101, United States. Email: diek@u.washington.edu SOURCE American Journal of Bioethics (2010) 10:1 (30-44). Date of Publication: January 2010 ISSN 1526-5161 1536-0075 (electronic) BOOK PUBLISHER Routledge, 4 Park Square, Milton Park, Abingdon, Oxfordshire, United Kingdom. ABSTRACT The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. © Taylor & Francis Group, LLC. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) estrogen (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) body height decision making developmental disorder (complication) disabled person ethics hysterectomy mastectomy mental deficiency (complication) parent precocious puberty (complication, drug therapy, surgery, therapy) professional standard quality of life EMTREE MEDICAL INDEX TERMS child child advocacy contraception drug effect family female hospital human medical ethics personal autonomy personhood prognosis review uncertainty LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 20077335 (http://www.ncbi.nlm.nih.gov/pubmed/20077335) PUI L358184245 DOI 10.1080/15265160903469336 FULL TEXT LINK http://dx.doi.org/10.1080/15265160903469336 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 397 TITLE Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study AUTHOR NAMES Belkora J.K. Loth M.K. Volz S. Rugo H.S. AUTHOR ADDRESSES (Belkora J.K., jeff.belkora@ucsfmedctr.org; Loth M.K.; Volz S.; Rugo H.S.) University of California, San Francisco, United States. CORRESPONDENCE ADDRESS J.K. Belkora, University of California, San Francisco, United States. Email: jeff.belkora@ucsfmedctr.org SOURCE Patient Education and Counseling (2009) 77:3 (360-368). Date of Publication: December 2009 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. Methods: We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions. Results: The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test. Conclusion: This case illustrates how decision support interventions can be deployed to promote patient-centered care. Practice implications: Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries. © 2009 Elsevier Ireland Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system patient care EMTREE MEDICAL INDEX TERMS adult article attitude to illness audio recording breast cancer case report case study communication aid consultation female genetic counseling health care practice health program human interpersonal communication patient autonomy patient decision making patient satisfaction priority journal prognosis self concept theory-practice relationship EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009610934 MEDLINE PMID 19850438 (http://www.ncbi.nlm.nih.gov/pubmed/19850438) PUI L50677414 DOI 10.1016/j.pec.2009.09.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2009.09.012 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 398 TITLE Use and evaluation of a decision aid for patients with T1 stage breast cancer ORIGINAL (NON-ENGLISH) TITLE Einsatz und Bewertung einer Entscheidungshilfe f r Patientinnen mit Brustkrebs im T1-Stadium AUTHOR NAMES Schulze-Rath R. Husmann G. Kaiser M. Kolpatzik K. Münster E. Nübling M. Zeeb H. AUTHOR ADDRESSES (Schulze-Rath R.; Husmann G.; Kaiser M.; Zeeb H., zeeb@imbei.uni-mainz.de) Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany. (Kolpatzik K.) AOK-Bundesverband, Stabsbereich Medizin, Berlin, Germany. (Münster E.) Institut für Arbeits-, Sozial- und Umweltmedizin, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany. (Nübling M.) Gesellschaft für Empirische Beratung MbH, Denzlingen, Germany. CORRESPONDENCE ADDRESS H. Zeeb, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany. Email: zeeb@imbei.uni-mainz.de SOURCE Geburtshilfe und Frauenheilkunde (2009) 69:5 (406-412). Date of Publication: 2009 ISSN 0016-5751 1438-8804 (electronic) BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. ABSTRACT PURPOSE: Shared decision making using decision aids is becoming more common internationally as patients get more involved in healthcare decisions. In Germany decision aids are not yet widely used. A newly developed decision aid for women with T1 stage breast cancer contains extensive information on both breast-conserving therapy and breast removal to support the patient's decision-making process. We studied how patients and physicians evaluated the decision aid and the options for its use. MATERIAL AND METHODS: The decision aid was presented to patients with a primary diagnosis of breast cancer, members of a self-help group, physicians in specialised hospitals and gynaecologists in private practice. In a cross-sectional study, participants were asked to complete a questionnaire which included questions on the acceptance and implementation of the decision aid in daily routines. The data were analysed descriptively. RESULTS: During the study 18 newly diagnosed patients, 42 members of a self-help group, 11 physicians and psycho-oncologists of various hospitals and 150 gynaecologists in private practice participated. The participants evaluated the use of the decision aid positively. Both hospital-based physicians and gynaecologists in private practice should have a role in giving the decision aid to patients. The decision aid is best given to the patient in the period shortly after the diagnosis is confirmed and before the therapy plan is finalised, usually 414 days after diagnosis. Gynaecologists in private practice preferred giving the decision aid to patients at the second consultation. CONCLUSION: The decision aid was evaluated positively. Standardised procedures for use may be helpful to support the regular utilisation of decision aids in a clinical setting. A translation of the decision aid into the languages spoken by the main immigrant groups in Germany should be considered. © Georg Thieme Verlag KG Stuttgart, New York. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) medical decision making EMTREE MEDICAL INDEX TERMS adult article cancer research clinical article clinical practice clinical trial conservative treatment controlled study female human multicenter study EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2010122912 PUI L358330085 DOI 10.1055/s-0029-1185635 FULL TEXT LINK http://dx.doi.org/10.1055/s-0029-1185635 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 399 TITLE Is informed, shared decision making achievable as part of cancer care? AUTHOR NAMES Hollen P. AUTHOR ADDRESSES (Hollen P.) Oncology Nursing, University of Virginia, United Kingdom. CORRESPONDENCE ADDRESS P. Hollen, Oncology Nursing, University of Virginia, United Kingdom. SOURCE Asia-Pacific Journal of Clinical Oncology (2009) 5 SUPPL. 2 (A162). Date of Publication: November 2009 CONFERENCE NAME 36th Annual Scientific Meeting of the Clinical Oncological Society of Australia, COSA CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2009-11-17 to 2009-11-19 ISSN 1743-7555 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Many patients with advanced lung cancer and their supporters struggle with treatment decisions. Patient preparation for facing consequential decisions concerning chemotherapy is difficult to achieve in most clinical practices. O'Connor and colleagues (JOGNN 2002) have delineated eight modifiable factors: lack of knowledge, unrealistic expectations, unclear values, unclear perceptions of others, social pressure, lack of support, lack of skills or self confidence, and lack of resources. Decisional conflict related to consequential decisions, including healthcare decisions, is not a new concept (Janis and Mann, 1977, 1982). However, recently decision aids have been developed to help this problem, with many of these developed and tested in Canada, the UK, and Australia. According to the International Patient Decision Aids Standards (IPDAS) Collaboration, decision aids are evidence-based tools designed to prepare patients and families to participate in making choices among options (O'Connor et al., Med Decis Making 2007). Patient decision aids supplement and enhance rather than replace clinicians' counseling about options. These decision aids have utilized a variety of formats (including balance sheet charts, videos, workbooks, pamphlets, and computer programs). In the more than 200 decision aids registered in the Cochrane Decision Aid Library Inventory, few target patients with advanced cancer (Stacey et al., CA Cancer J Clin 2008). Our research has focused on decision aids in lung cancer and in breast cancer. This presentation will review existing decision aids for lung cancer and will outline results of two feasibility studies within a program of research for an interactive decision aid. This work is based on the Janis and Mann's conflict theory of decision making and is conducted in collaboration with Dr. Leon Mann, University of Melbourne, who is instrumental in providing the theory as the underpinning framework. The goal of this practical decision aid is to 1) enhance informed, shared treatment decision making; 2) to reduce decisional conflict; and 3) to decrease ultimate regret as part of daily oncology practice. EMTREE DRUG INDEX TERMS deltamethrin salicylate sodium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia decision making neoplasm society EMTREE MEDICAL INDEX TERMS advanced cancer breast cancer Canada chemotherapy clinical practice counseling evidence based practice feasibility study health care library lung cancer oncology patient skill social problem software United Kingdom university videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70208226 DOI 10.1111/j.1743-7563.2009.01253.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1743-7563.2009.01253.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 400 TITLE Factors influencing implementation of decisions made within a multi-disciplinary breast team AUTHOR NAMES English R. Blazeby J. Metcalfe C. Winters Z. Rayter Z. Day J. AUTHOR ADDRESSES (English R.; Winters Z.; Rayter Z.) University Hospitals Bristol NHS Foundation Trust, Bristol, Upper Maudlin Street, Bristol, United Kingdom. (Blazeby J.; Day J.) Division of Surgery, Head and Neck, University of Bristol, United Kingdom. (Metcalfe C.) University of Bristol, United Kingdom. CORRESPONDENCE ADDRESS R. English, University Hospitals Bristol NHS Foundation Trust, Bristol, Upper Maudlin Street, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2009) 35:11 (1235). Date of Publication: November 2009 CONFERENCE NAME Joint Scientific Conference of the ABS, BASO - ACS and Cancer Genetics Group CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2009-11-23 to 2009-11-24 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: In the UK it is mandatory for clinical decisions concerning patients with known or suspected breast cancer to be made within the context of a multi-disciplinary team (MDT). However, MDT efficiency and whether MDT decisions are implemented is unknown. Evidence suggests that decisions may change after the meeting which could reflect an inefficient process. This study investigated the implementation rates of MDT treatment decisions and examined factors associated with changed decisions. Methods: Consecutive MDT decisions, subsequent treatment implementation and basic patient details were prospectively recorded from specialist breast MDT meetings. When MDT decisions were not implemented, the case was examined in detail. Results: 299 consecutive treatment decisions concerning 213 patients were analysed. Twenty-two decisions (7.4%, 95% CI 4.7% to 10.9%) were not implemented. Non-implementation was due to patient choice (n1/4 14, 63%), discovery of new clinical information following the MDT discussion (n1/4 4, 18%) or individual doctors changing the MDT plan (n1/4 4, 18%). MDT decisions were significantly more likely to change in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001). A significant trend was also noted for non-implementation of MDT recommendations in patients with increasing age (p < 0.006). Conclusions: Clinical decisions made within the context of a specialist breast MDT are usually implemented. The main reason for changes in treatment is related to patient choice. Decisions change more frequently in older patients and those with proven malignancy. Further work is needed to develop ways of including patient related factors into team decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer genetics EMTREE MEDICAL INDEX TERMS breast cancer decision making medical specialist patient physician United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70150558 DOI 10.1016/j.ejso.2009.07.128 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2009.07.128 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 401 TITLE Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation AUTHOR NAMES Pacifico M.D. See M.S. Cavale N. Collyer J. Francis I. Jones M.E. Hazari A. Boorman J.G. Smith R.W. AUTHOR ADDRESSES (Pacifico M.D., marcpacifico@dial.pipex.com; See M.S.; Cavale N.; Jones M.E.; Hazari A.; Boorman J.G.; Smith R.W.) Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom. (Collyer J.) Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom. (Francis I.) Department of Radiology, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom. CORRESPONDENCE ADDRESS M.D. Pacifico, Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom. Email: marcpacifico@dial.pipex.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2009) 62:11 (1464-1469). Date of Publication: November 2009 ISSN 1748-6815 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT The deep inferior epigastric perforator (DIEP) flap is normally the first choice in breast reconstruction; however, due to the considerable vascular anatomical variation and the learning curve for the procedure, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flaps are still frequently performed to reduce the rate of complications. Accurate preoperative investigation of the perforators would allow better operative preparation and possibly shorten the learning curve. In an effort to increase accuracy of preoperative planning and to aid preoperative decision-making in free abdominal flap breast reconstruction, we have acquired the use of VoNavix, software that creates three dimensional images from computerised tomography angiography (CTA) data. The use of the VoNavix software for analysis of CTA provides superior imaging that can be viewed in theatre. It, together with CTA, enables decisions to be made preoperatively, including: which side to raise the flap; whether to aim for a medial or lateral row perforator; whether to take a segment of muscle and whether to expect an easy or difficult dissection. We have now performed over 60 free abdominal flap breast reconstructions aided with CTA, and 10 of these cases also used VoNavix technology. This paper presents our initial experience with the use of this software, illustrated with three patient examples. The advantages and disadvantages are discussed. © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adult article case report computed tomographic angiography female human imaging system medical decision making preoperative period priority journal software treatment planning DEVICE TRADE NAMES VoNavix EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009644374 MEDLINE PMID 18708309 (http://www.ncbi.nlm.nih.gov/pubmed/18708309) PUI L50241286 DOI 10.1016/j.bjps.2008.04.056 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2008.04.056 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 402 TITLE Consenting the patient with early-stage breast cancer: "Informed" only after multi-discliplinary evaluation AUTHOR NAMES Mohiuddin M.M. Regine W.F. AUTHOR ADDRESSES (Mohiuddin M.M.; Regine W.F.) Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States. CORRESPONDENCE ADDRESS M. M. Mohiuddin, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States. SOURCE Journal of Clinical Oncology (2009) 27:30 (e158-e159). Date of Publication: 20 Oct 2009 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) early cancer (disease management, surgery) informed consent patient decision making EMTREE MEDICAL INDEX TERMS body image breast biopsy breast reconstruction breast surgery cancer mortality cancer radiotherapy cancer recurrence cancer risk cancer surgery consultation decision support system disease free survival follow up human intermethod comparison letter lymph node metastasis mastectomy morbidity nuclear magnetic resonance imaging overall survival partial mastectomy partial mastectomy patient counseling patient satisfaction patient selection priority journal prophylaxis quality of life questionnaire recurrence risk sexuality systemic therapy treatment failure tumor volume EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010139756 MEDLINE PMID 19687330 (http://www.ncbi.nlm.nih.gov/pubmed/19687330) PUI L358374159 DOI 10.1200/JCO.2009.22.6332 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2009.22.6332 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 403 TITLE Perceptions of High-Risk Care and Barriers to Care Among Women at Risk for Hereditary Breast and Ovarian Cancer following Genetic Counseling in the Community Setting AUTHOR NAMES Morgan D. Sylvester H. Lucas F.L. Miesfeldt S. AUTHOR ADDRESSES (Morgan D.; Miesfeldt S., miesfs@mccm.org) Maine Medical Center Research Institute, Scarborough, United States. (Sylvester H.; Miesfeldt S., miesfs@mccm.org) Maine Center for Cancer Medicine and Blood Disorders, 100 U.S. Route One, Scarborough, 04074, United States. (Lucas F.L.; Miesfeldt S., miesfs@mccm.org) Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, United States. CORRESPONDENCE ADDRESS S. Miesfeldt, Maine Center for Cancer Medicine and Blood Disorders, 100 U.S. Route One, Scarborough, 04074, ME, United States. Email: miesfs@mccm.org SOURCE Journal of Genetic Counseling (2009) (1-11). Date of Publication: 2009 ISSN 1059-7700 1573-3599 (electronic) ABSTRACT Data are limited regarding barriers to care among women, with or at risk for hereditary breast and ovarian cancer (HBOC), following genetic counseling in the community setting. Using a telephone survey, we retrospectively addressed perceptions of post-genetic counseling medical care and barriers to care among 69 at-risk women from the non-academic setting. Of these, all agreed that following cancer screening recommendations was better than not following them; none felt recommendations were too difficult to follow; all believed screening would help keep them healthy; 57% believed screening would prevent cancer. Twenty-five percent noted discomfort with breast imaging; 29% found ovarian cancer screening uncomfortable. Close to a quarter of participants reported difficulty deciding whether or not to undergo risk-reducing mastectomy while 10% noted difficulty deciding for or against bilateral salpingo-oophorectomy. There were no perceived major barriers to care, although 38% felt that screening reminders would be helpful, and 10% needed more help in following through with care. Overall, participants believed that they were benefiting from their post-genetic counseling medical care. This work identified HBOC-related support needs to include: informational resources that promote improved understanding of cancer risk and high-risk management; screening reminder systems; and decision support tools. © 2009 National Society of Genetic Counselors, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer screening community female genetic counseling genetic risk ovary cancer risk risk assessment surgery EMTREE MEDICAL INDEX TERMS cancer risk decision support system imaging mastectomy medical care neoplasm reminder system risk management salpingooophorectomy screening society telephone LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 19809867 (http://www.ncbi.nlm.nih.gov/pubmed/19809867) PUI L50664555 DOI 10.1007/s10897-009-9261-9 FULL TEXT LINK http://dx.doi.org/10.1007/s10897-009-9261-9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 404 TITLE Risk factors and complications in reduction mammaplasty: Novel associations and preoperative assessment AUTHOR NAMES Henry S.L. Crawford J.L. Puckett C.L. AUTHOR ADDRESSES (Henry S.L.; Crawford J.L.) Division of Plastic Surgery, University of Missouri, . (Puckett C.L., bolandd@health.missouri.edu) Division of Plastic Surgery, One Hospital Drive, Columbia, Mo 65212, United States. CORRESPONDENCE ADDRESS C. L. Puckett, Division of Plastic Surgery, One Hospital Drive, Columbia, Mo 65212, United States. Email: bolandd@health.missouri.edu SOURCE Plastic and Reconstructive Surgery (2009) 124:4 (1040-1046). Date of Publication: October 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND:: Although risk factors for complications following reduction mammaplasty are well known, it is difficult to assess risk for specific complications among patients with multiple factors or varying gradations of a single factor. The purpose of this study was to identify all associations between patient characteristics and specific complications and to quantify the risk attributable to these factors, to assess a prospective patient's individualized risk. METHODS:: Patient characteristics and complications were identified through retrospective chart review of a consecutive series of patients who underwent Wise-pattern, inferior-pedicle reduction mammaplasty performed by the senior author (C.L.P.) over the past 10 years. Chi-square, t test, logistic regression, and decision tree analyses were used to identify complications attributable to specific risk factors and, when possible, to quantify the risk imparted by those factors. RESULTS:: The charts of 485 patients were reviewed. Factors predictive of nonspecific complications included hypertension, fibromyalgia, previous breast surgery, and fibroproliferative breast abnormality. Factors predictive of specific complications included body mass index, associated with wound-healing complications; mass of resection, associated with wound-healing complications and decreased nipple sensitivity and inversely related to hypertrophic scarring; and intraoperative hypotension, associated with hematoma. CONCLUSIONS:: Based on the review of a large series of reduction mammaplasties, specific and quantifiable patient characteristics were linked to specific and quantifiable complications. Novel associations were drawn, including increased risk of hematoma with intraoperative hypotension and decreased risk of hypertrophic scarring with mass of resection. A "risk assessor" was constructed that estimates a prospective patient's individualized risk based on selected preoperatively identifiable characteristics, facilitating patient selection and preoperative counseling. Copyright © 2009 by the American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reduction EMTREE MEDICAL INDEX TERMS adolescent adult aged article body mass breast areola comorbidity controlled study female fibromyalgia (complication) hematoma (complication) human hypertension (complication) hypertrophic scar (complication) hypotension (complication) lung embolism (complication) major clinical study neuroma (complication) obesity pneumothorax (complication) preoperative evaluation priority journal risk factor thrombophlebitis (complication) wound healing impairment (complication) EMBASE CLASSIFICATIONS Surgery (9) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009533160 MEDLINE PMID 19935287 (http://www.ncbi.nlm.nih.gov/pubmed/19935287) PUI L355399749 DOI 10.1097/PRS.0b013e3181b45410 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181b45410 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 405 TITLE The benefits of patient involvement in breast cancer informed decision making (IDM) program AUTHOR NAMES Golesorkhi N. Erb K.M. Gudenburr H. Jeffries M. Julian T.B. AUTHOR ADDRESSES (Golesorkhi N.; Erb K.M.; Gudenburr H.; Jeffries M.; Julian T.B.) SOURCE American Journal of Clinical Oncology: Cancer Clinical Trials (2009) 32:5 (551). Date of Publication: October 2009 CONFERENCE NAME 19th Annual National Interdisciplinary Breast Center Conference of the National Consortium of Breast Centers, NCBC CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2009-03-16 to 2009-03-18 ISSN 0277-3732 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objective: Cancer patient participation in care decision making processes is critical. The IDM program is designed to educate newly diagnosed breast cancer patients with the decision-making process prior to the surgical visit. The benefit and results of the IDM Program are reviewed. Methods: A retrospective review of interviews and questionnaires from early stage breast cancer patients (March 2006-March 2008) was performed. Following the initial diagnosis of breast cancer, the patients were introduced to the IDM program via a telephone interview, provided decision making aids, consisting of DVDs and booklets, prior to the visit with a surgeon. Feedback was collected through questionnaires at four time points over one year, to assess knowledge base, comfort with decision-making, quality of life, and program satisfaction. Results: 125 newly diagnosed early stage invasive breast cancer patients were offered the IDM program, with 109 (87%) participants. 82 (66%) completed the program to a 4 week follow-up period in which 56 (45%) completed the entire 1 year program. Average age of patients was 57 (27-79), 80 Caucasian (97.6%), one African-American (1.22%), and one Asian (1.22%). 85% (71/82) had some college level education, 2.4% had some high school and 11% had post college education. There was a 33% improvement in the knowledge base following IDM participation. 30.5% of patients perceived needing a more extensive procedure (i.e. mastectomy). 97.6% and 98.2% of patients expressed agreement with their treatment plan at 4wk and one year period respectively. Following IDM participation patient optimism about their prognosis improved (26.8%, P = 0.59, CI 95%), significantly after discussion with the surgeon (34.1%, P = 0.05, CI 95%), by 4wk (35.4%, P = 0.49, CI 95%), and in one year (32%, P = 0.92, CI 95%). Patients' confidence improved with program participation (20.7% P = 0.72, CI 95%), and significantly upon discussion with the surgeon (30.5% P = 0.004). Distress level significantly decreased by 4wk (58.5%, P = 0.0164, CI 95%) and upon completion of the program at one year (77%, P = 0.0001, CI 95%). Conclusion: The role of health care workers in educating and counseling patients with breast cancer has become very challenging. The IDM Program significantly improves the knowledge base, comfort level with decision-making, and health related quality of life for breast cancer patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer decision making patient participation EMTREE MEDICAL INDEX TERMS African American Asian cancer patient Caucasian college counseling diagnosis education feedback system follow up health care personnel high school interview knowledge base mastectomy optimism patient prognosis quality of life questionnaire satisfaction surgeon telephone LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70038648 DOI 10.1097/COC.0b013e3181b7b8b5 FULL TEXT LINK http://dx.doi.org/10.1097/COC.0b013e3181b7b8b5 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 406 TITLE In the moment: women speak about surgical treatment decision making days after a breast cancer diagnosis. AUTHOR NAMES Lally R.M. AUTHOR ADDRESSES (Lally R.M.) School of Nursing, University of Buffalo, New York, USA. CORRESPONDENCE ADDRESS R.M. Lally, School of Nursing, University of Buffalo, New York, USA. Email: rmlally@buffalo.edu SOURCE Oncology nursing forum (2009) 36:5 (E257-265). Date of Publication: Sep 2009 ISSN 1538-0688 (electronic) ABSTRACT PURPOSE/OBJECTIVES: To explore the pretreatment thoughts and behaviors of women newly diagnosed with breast cancer regarding their surgical treatment decision-making experience. RESEARCH APPROACH: Qualitative, descriptive. SETTING: A multispecialty breast center in the midwestern region of the United States. PARTICIPANTS: 18 English-speaking women, aged 37-87 years, mean of 12 days postdiagnosis of clinical stage 0-11 breast cancer. METHODOLOGIC APPROACH: Open to semistructured interviews were conducted during the period following surgical consultation but prior to surgical treatment. Transcribed interviews, originally analyzed to identify the psychological processes of women in response to breast cancer diagnosis, were additionally analyzed using directed content analysis focusing on women's thoughts and behaviors related to their surgical treatment decision-making process. MAIN RESEARCH VARIABLES: Breast cancer surgery and decision making pretreatment. FINDINGS: Women's pretreatment thoughts and behaviors related to surgical treatment decision making were characterized by information processing, contemplating options, and interacting with others. Breast cancer information was used by women before the surgical consultation and after treatment decisions had been made. Treatment options were contemplated and preferences formed often before the initial surgical consultation. Women associated having options with a better prognosis. Age was a factor primarily in the type of information women desired. CONCLUSIONS: Most women made their own surgical treatment decisions with ease, supported by the confidence instilled by their surgeons and oncology nurses. INTERPRETATION: The findings provide oncology nurses with insight regarding women's desire for and use of information and their contemplation of surgical options, therefore suggesting areas on which to focus clinical assessment and to test tailored interventions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health breast tumor (diagnosis, surgery) patient participation EMTREE MEDICAL INDEX TERMS adult aged article decision making emotion female human human relation mastectomy methodology middle aged motivation nursing oncology nursing patient education psychological aspect qualitative research LANGUAGE OF ARTICLE English MEDLINE PMID 19726385 (http://www.ncbi.nlm.nih.gov/pubmed/19726385) PUI L355886439 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 407 TITLE Case 25-2009: A 36-year-old woman with hormone-receptor-positive breast cancer AUTHOR NAMES Burstein H.J. Souter I. D'Alessandro H.A. Sgroi D.C. AUTHOR ADDRESSES (Burstein H.J.) Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States. (Burstein H.J.) Department of Medicine, Brigham and Women's Hospital, Boston, United States. (Souter I.) Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA, United States. (D'Alessandro H.A.) Department of Radiology, Massachusetts General Hospital, Boston, MA, United States. (Sgroi D.C.) Department of Pathology, Massachusetts General Hospital, Boston, MA, United States. (Burstein H.J.) Department of Medicine, Harvard Medical School, Boston, United States. (Souter I.) Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, United States. (D'Alessandro H.A.) Department of Radiology, Harvard Medical School, Boston, United States. (Sgroi D.C.) Department of Pathology, Harvard Medical School, Boston, United States. CORRESPONDENCE ADDRESS H. J. Burstein, Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, United States. SOURCE New England Journal of Medicine (2009) 361:7 (699-707+652). Date of Publication: 13 Aug 2009 ISSN 0028-4793 1533-4406 (electronic) BOOK PUBLISHER Massachussetts Medical Society, 860 Winter Street, Waltham, United States. ABSTRACT A 36-year-old woman was seen in the multidisciplinary breast cancer clinic of this hospital for management of hormone-receptor-positive breast cancer. She had a 1.4-cm, grade 2 of 3, infiltrating ductal carcinoma that was positive for estrogen-receptor protein and progesterone-receptor protein and negative for human epidermal growth factor receptor type 2, with micrometastases to 1 of 13 axillary lymph nodes detected by immunohistochemical analysis. A management decision was made. Copyright © 2009 Massachusetts Medical Society. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) estrogen receptor (endogenous compound) progesterone receptor (endogenous compound) EMTREE DRUG INDEX TERMS BRCA1 protein BRCA2 protein leuprorelin (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, diagnosis, drug therapy, radiotherapy) EMTREE MEDICAL INDEX TERMS anamnesis article axillary lymph node breast biopsy breast tumor (diagnosis, surgery) cancer grading cancer survival differential diagnosis digital mammography female fertility histopathology human intraductal carcinoma (diagnosis) outcome assessment partial mastectomy priority journal protein expression risk assessment sperm donor CAS REGISTRY NUMBERS leuprorelin (53714-56-0, 74381-53-6) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Clinical and Experimental Biochemistry (29) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009434784 MEDLINE PMID 19675333 (http://www.ncbi.nlm.nih.gov/pubmed/19675333) PUI L355109704 DOI 10.1056/NEJMcpc0902224 FULL TEXT LINK http://dx.doi.org/10.1056/NEJMcpc0902224 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 408 TITLE Factors influencing changes in employment among women with newly diagnosed breast cancer AUTHOR NAMES Hassett M.J. O'Malley A.J. Keating N.L. AUTHOR ADDRESSES (Hassett M.J., mhassett@partners.org) Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States. (O'Malley A.J.; Keating N.L.) Department of Health Care Policy, Harvard Medical School, Boston, MA, United States. (Keating N.L.) Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States. (Hassett M.J., mhassett@partners.org) Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115-6084, United States. CORRESPONDENCE ADDRESS M. J. Hassett, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115-6084, United States. Email: mhassett@partners.org SOURCE Cancer (2009) 115:12 (2775-2782). Date of Publication: 15 Jun 2009 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND: Although studies have demonstrated that women are less likely to work after they are diagnosed with breast cancer, the influence of cancer treatments on employment is less clear. The authors of this report assessed whether chemotherapy or radiation therapy was associated with a disruption in employment during the year after a breast cancer diagnosis. METHODS: Using a database of health insurance claims that covered 5.6 million US residents, 3233 women aged ≤63 years were identified who were working full time or part time when they were diagnosed with breast cancer between 1998 and 2002. All changes in employment during the year after a breast cancer diagnosis were identified. Using a Cox proportional hazards model that incorporated time-varying treatment variables, the authors evaluated the impact of chemotherapy and radiation therapy on the likelihood of experiencing an employment disruption. RESULTS: Although most women (93%) continued to work, chemotherapy recipients were more likely than nonrecipients to go on long-term disability, stop working, or retire (hazards ratio, 1.8; P < .01). Women aged >54 years were more likely to experience a change in employment than women aged <44 years (P < .01). Radiation therapy did not influence employment (P=.22). CONCLUSIONS: In this population of employed, insured women, chemotherapy had a negative impact on employment. This finding may aid treatment decision making and could foster the development of interventions that support a patient's ability to continue working after treatment. It also reinforces the need to assess the impact of treatments, especially new treatments, on patient-centered outcomes such as employment. © 2009 American Cancer Society. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy) cancer chemotherapy cancer radiotherapy employment of women EMTREE MEDICAL INDEX TERMS adult age distribution article cancer diagnosis controlled study data base female human major clinical study parttime employment priority journal retirement treatment outcome work disability EMBASE CLASSIFICATIONS Cancer (16) Occupational Health and Industrial Medicine (35) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009308681 MEDLINE PMID 19365847 (http://www.ncbi.nlm.nih.gov/pubmed/19365847) PUI L354783519 DOI 10.1002/cncr.24301 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.24301 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 409 TITLE Pilot evaluation of a decision aid for chinese women considering breast cancer surgery for localized breast cancer AUTHOR NAMES Lam W.W.T. Chan M. Kwong A. Or A. Suen D. Butow P.N. Fielding R. AUTHOR ADDRESSES (Lam W.W.T.; Kwong A.; Suen D.; Fielding R.) University of Hong Kong, Hong Kong, Hong Kong. (Chan M.; Or A.) Kwong Wah Hospital, Hong Kong, Hong Kong. (Butow P.N.) University of Sydney, Sydney, Australia. CORRESPONDENCE ADDRESS W.W.T. Lam, University of Hong Kong, Hong Kong, Hong Kong. SOURCE Psycho-Oncology (2009) 18 SUPPL. 2 (S318). Date of Publication: June 2009 CONFERENCE NAME 11th World Congress of Psycho-Oncology of the International Psycho-Oncology Society, IPOS CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-06-21 to 2009-06-25 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT BACKGROUND: We developed and piloted a decision aid (DA) booklet for Chinese women with localized breast cancer (BC) considering breast cancer surgery. This is probably the first DA designed specifically for non-Caucasian cancer patients. The current study tested the acceptability of the DA booklet to assist Chinese women facing breast cancer treatment decision-making (TDM). METHOD: Chinese women diagnosed with localized breast cancer were invited to evaluate the DA booklet. A total of 95 women received the DA booklet at the end of their initial diagnostic consultation. Questionnaires evaluating attitudes toward the DA booklet, patients' understanding of BC treatment and preference for decision involvement were completed four days after the initial consultation. The questionnaire was completed using a face-to-face interview. RESULTS: Most women (88%) had read/partly read the DA booklet; 73% found it useful in choosing BC surgery. Most found that the DA was easy to understand (89%), facilitated their understanding of information obtained from their surgeon (87%), and was not anxiety provoking (77%). Women found the DA eased TDM (84%). Women who read (mean 7.17) or partly read (mean 4.71) the DA had a better understanding of BC than those who did not read the booklet (mean 2.91, p<.001). Women preferring passive participation were less likely to read the booklet compared to those preferring active/shared decision making participation (p=.025). CONCLUSIONS: Our findings suggest that the DA booklet is acceptable to Chinese women deciding for breast cancer surgery. Consistent with previous studies, the DA booklet increased Chinese women's knowledge of BC and its treatment. RESEARCH IMPLICATIONS: The DA booklet has been revised to make it more parsimonious and enhance its clarity, particularly for sub-literate women. The revised DA booklet is being evaluated in a randomized controlled trial. CLINICAL IMPLICATIONS: Previous studies showed difficulties in treatment decision making (TDM) leads to persistent psychological distress among Chinese women with BC. If effective in improving health outcomes, the DA could be used in facilitate TDM, thereby minimizing subsequent psychological distress. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer surgery female oncology society EMTREE MEDICAL INDEX TERMS anxiety cancer patient cancer therapy Caucasian consultation decision making diagnosis distress syndrome health interview patient questionnaire randomized controlled trial surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70333503 DOI 10.1002/pon.1594 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1594 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 410 TITLE Percutaneous needle biopsy for breast diagnosis: How do surgeons decide? AUTHOR NAMES Holloway C.M.B. Gagliardi A.R. AUTHOR ADDRESSES (Holloway C.M.B., claire.holloway@sunnybrook.ca; Gagliardi A.R.) Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. CORRESPONDENCE ADDRESS C. M. B. Holloway, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. Email: claire.holloway@sunnybrook.ca SOURCE Annals of Surgical Oncology (2009) 16:6 (1629-1636). Date of Publication: June 2009 ISSN 1068-9265 1534-4681 (electronic) BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT Background: Despite the advent of guidelines recommending core needle biopsy (CNB) for diagnosis of breast abnormalities, it is underused in some jurisdictions. We sought to determine those factors influencing surgeons' choices of breast biopsy techniques. Methods: We surveyed 385 general surgeons in Ontario to first determine factors influencing the choice of fine-needle aspiration biopsy (FNAB), CNB, both or neither for diagnosis of breast abnormalities in six clinical scenarios with varying risk of malignancy. Second, respondents were asked to rate 15 patient, organizational, and system factors for their impact on choice of biopsy technique. Third, surgeons were asked to describe their three greatest barriers to provision of cancer care. Results: Response rate was 44%, and 126 provided answers to the survey questions. When there was a high risk of malignancy, CNB and/or FNAB were favored over surgical biopsy (83% to 97% compared with 41% for presumed benign lesions), and CNB was preferred for percutaneous biopsy over FNAB (58% to 79% compared with 1% to 18%). Patient and clinical factors (46% FNAB, 42% CNB), patient preference for biopsy technique (34%, 31%), and delayed access to CNB, rather than lack of equipment (11% FNAB, 8% CNB) or expertise for CNB or FNAB (15%, 12%), had the greatest reported impact on choice of biopsy technique. Conclusions: Surgeon preference for CNB is higher than actual use. Further research is needed to establish whether or how CNB use could be improved by support for shared decision making or facilitating access. © 2009 Society of Surgical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast biopsy breast disease (diagnosis) needle biopsy percutaneous biopsy EMTREE MEDICAL INDEX TERMS adult article breast cancer (diagnosis) Canada clinical feature female fine needle aspiration biopsy health care access human male medical decision making normal human rating scale surgeon EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009249248 MEDLINE PMID 19357925 (http://www.ncbi.nlm.nih.gov/pubmed/19357925) PUI L50483148 DOI 10.1245/s10434-009-0451-3 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-009-0451-3 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 411 TITLE Doctor-patient communication about advance directives in metastatic breast cancer AUTHOR NAMES Ozanne E.M. Partridge A. Moy B. Ellis K.J. Sepucha K.R. AUTHOR ADDRESSES (Ozanne E.M.) Institute for Technology Assessment, . (Ozanne E.M.; Partridge A.; Moy B.; Ellis K.J.; Sepucha K.R., ksepucha@partners.org) Harvard Medical School, Boston, MA, United States. (Partridge A.) Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA, United States. (Moy B.; Ellis K.J.) Cancer Center, . (Sepucha K.R., ksepucha@partners.org) Health Decision Research Unit, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States. CORRESPONDENCE ADDRESS K. R. Sepucha, Health Decision Research Unit, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States. Email: ksepucha@partners.org SOURCE Journal of Palliative Medicine (2009) 12:6 (547-553). Date of Publication: 1 Jun 2009 ISSN 1096-6218 BOOK PUBLISHER Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States. ABSTRACT Purpose: Oncology providers often find it difficult to discuss end-of-life issues with patients and assume that patients are reluctant to think about the issues involved. This study examined whether or not patients with metastatic breast cancer had advance directives, and if so, with whom they discussed written plans for end-of-life decisions. Patients and methods: A cross-sectional sample of 32 women with metastatic breast cancer and their providers from two academic medical centers in the United States were surveyed at baseline and again 3 months later about advance directives, decision-making goals, and their expectations. After the baseline assessment, patients viewed a decision aid that discussed choices for treatment of metastatic disease. The patients' experience with advance directives in addition to associations between advance directives and patient preferences regarding end-of-life care, demographics, and clinical characteristics were analyzed. Results: At baseline, the majority of women had gathered information (75%) about or had written (66%) advance directives. These percentages increased at 3 months. Providers were only aware of the presence of an advance directive in a minority of cases (14%). Patients were more than three times as likely to talk to and share written plans with family and friends than with their providers. Conclusions: The majority of patients gathered information about advance directives and had made written plans, yet few discussed these plans with their providers. Explicit discussion of advance directives and patient preferences regarding end-of-life care are lacking in this setting. Facilitation of doctor-patient communication about end-of-life care is needed in order to provide quality patient care at this difficult time. © Mary Ann Liebert, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer doctor patient relation living will metastasis EMTREE MEDICAL INDEX TERMS adult aged article clinical article decision making disease severity female human quality of life EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009495932 MEDLINE PMID 19508141 (http://www.ncbi.nlm.nih.gov/pubmed/19508141) PUI L355282711 DOI 10.1089/jpm.2008.0254 FULL TEXT LINK http://dx.doi.org/10.1089/jpm.2008.0254 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 412 TITLE Integrating cancer care: Patient and practice management processes among surgeons who treat breast cancer AUTHOR NAMES Katz S.J. Hawley S.T. Griggs J.J. Morrow M. Hofer T.P. AUTHOR ADDRESSES (Katz S.J.; Hawley S.T.; Griggs J.J.; Morrow M.; Hofer T.P.) CORRESPONDENCE ADDRESS S.J. Katz, SOURCE Journal of Clinical Oncology (2009) 27:15 SUPPL. 1 (6526). Date of Publication: 20 May 2009 CONFERENCE NAME 2009 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2009-05-29 to 2009-06-02 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: The Institute of Medicine has called for cancer care models that parallel those underway to integrate the management of patients with chronic conditions. The objective of this study was to evaluate patterns and correlates of such initiatives in the practices of surgeons treating women with breast cancer. Methods: We developed 5 multi-item scales to describe breast cancer patient and practice management processes based on the Chronic Care Model (multidisciplinary clinician communication; availability of clinical information; patient decision support; access to information technology; and practice management initiatives). We then performed a survey among attending surgeons of a population-based sample of patients diagnosed with breast cancer during a period from June 2005-February 2007 in metropolitan Los Angeles and Detroit (N = 312, response rate 76.1%). We evaluated the distribution of management process measures across selected characteristics of providers and practices. Results: About half of the surgeons devoted 15% or less of their total practice to breast cancer; while 16.2% of surgeons devoted 50% or more. The deployment of management processes varied markedly with most surgeons reporting low use. For example, only about 10% of surgeons indicated that half or more of their patients were exposed to multidisciplinary physician communication; while only 5% indicated that half or more of their patients were provided decision and care support services such as attending a presentation or viewing a video about breast cancer prior to surgery or attended a patient support group. Management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status (NCI center, ACS cancer program, neither) was weakly associated with any of the management process measures. Conclusions: The low uptake of patient and practice management processes observed in this study suggests that breast surgeons are not convinced that these processes matter or that there are logistical and cost barriers to implementation. More research is needed to understand how variation in patient and practice management processes may affect the quality of care for patients with breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer management neoplasm oncology patient society surgeon EMTREE MEDICAL INDEX TERMS access to information breast cancer patient decision support system female hospital patient information technology interpersonal communication model physician population specialization support group surgery teaching United States videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70241907 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 413 TITLE Electronic patient-reported data capture as the foundation of a learning health care system AUTHOR NAMES Abernethy A.P. Zafar S.Y. Coeytaux R. Rowe K. Wheeler J.L. Lyerly H.K. AUTHOR ADDRESSES (Abernethy A.P.; Zafar S.Y.; Coeytaux R.; Rowe K.; Wheeler J.L.; Lyerly H.K.) Duke University, Medical Center, Durham, United States. CORRESPONDENCE ADDRESS A.P. Abernethy, Duke University, Medical Center, Durham, United States. SOURCE Journal of Clinical Oncology (2009) 27:15 SUPPL. 1 (6522). Date of Publication: 20 May 2009 CONFERENCE NAME 2009 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2009-05-29 to 2009-06-02 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: In a “learning healthcare system” clinical decisions are supported by accurate information delivered at point of care; information gathered today iteratively informs future care and research. Methods: Customized software on wireless tablet personal computers presented a review of systems (ROS) instrument, validated research surveys (e.g., quality of life [QOL]), and a satisfaction survey, tailored by user. The system was piloted in the Duke Cancer Clinics and affiliated hospitals. We previously demonstrated equivalence of electronic and paper survey data. We conducted a series of studies using similar procedures to evaluate feasibility, acceptability, and utility. Results: First, we assessed the ability to collect ROS data at point of care to inform the clinic visit for participating breast (n = 65), gastrointestinal (n = 113), and lung (n = 97) cancer patients. Duke physicians reported that the system's clinical reports informed care and increased dictation efficiency. Second, we assessed patient satisfaction in the breast cancer cohort. Participants found the computers easy to read (94%), navigate (99%), and use (98%); the system helped 74% remember forgotten concerns to report to their clinician. Third, we assessed whether these data could contribute to current research. If the patient was on another clinical trial, PRO data (e.g., pain, QOL) were delivered to the investigator for research purposes in real time; data governance rules provided assurance to investigators. Fourth, we identified whether the PRO data could inform future research directions. Symptoms monitored longitudinally in aggregate uncovered unmet needs. Sexual distress was an underserved concern; intervention studies were initiated. Warehoused PRO data were integrated with clinical trials, genomic, biomarker, radiology, and administrative datasets for analyses. The approach has been scaled to 4 clinics and 3 hospitals. Conclusions: An integrated, real-time, electronic data capture system that interdigitates PROs with clinical and other data allows creation of a learning oncology environment that continuously improves care and research. Advantages include: patient-centeredness, description of the PRO phenotype, interoperability, and interface with caBIG infrastructure. EMTREE DRUG INDEX TERMS biological marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care system learning non profit organization oncology patient society EMTREE MEDICAL INDEX TERMS breast breast cancer cancer center cancer patient clinical trial computer environment hospital intervention study lung microcomputer pain patient satisfaction phenotype physician quality of life radiology satisfaction software tablet LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70241903 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 414 TITLE Updating familial cancer resources for consumers: An evidence based approach AUTHOR NAMES Ross D. Barlow-Stewart K. Dunlop K. Meiser B. Strong K. AUTHOR ADDRESSES (Ross D.; Barlow-Stewart K.; Dunlop K.) Centre for Genetics Education, NSW Health, Australia. (Meiser B.; Strong K.) Psychosocial Research Group, Department of Oncology, Prince of Wales Hospital, Sydney, Australia. CORRESPONDENCE ADDRESS D. Ross, Centre for Genetics Education, NSW Health, Australia. SOURCE Twin Research and Human Genetics (2009) 12:2 (230-231). Date of Publication: April 2009 CONFERENCE NAME Genes for Health Meeting, Incorporating the Inaugural GRaPH-Int Conference and the 33rd HGSA Annual Scientific Meeting CONFERENCE LOCATION Fremantle, WA, Australia CONFERENCE DATE 2009-05-03 to 2009-05-06 ISSN 1832-4274 BOOK PUBLISHER Australian Academic Press ABSTRACT Given the rapid progress in the field of cancer genetics, consumer focused education materials addressing topics relevant to families affected by hereditary cancer require regular evaluation and updating. As this is costly, evidence is needed of demand for this information, past and future potential usage and format preferences. An audit and evaluation of key familial cancer resources was undertaken. The audit used the CGE electronic database that tracks resource dissemination in NSW and interstate. An evaluation was undertaken with the NSW Familial Cancer Services and outreach genetic counseling services, as well as other interstate users. 28/42 completed the evaluation that sought to determine how the resource was used, preferred format, and desired edits. Findings for all the resources were similar with preference for format being print (61%-69%) with some wanting both print and electronic formats (31%-33%). Generally, for those who provided the material to clients (67%-83%), half used the material in consultations and half sent it home with the patient. The majority requested the information to be updated. Since the audit and evaluation two of the identified key resources addressing preventative surgery to manage cancer risk have undergone expert peer review and consumer testing; Information For Women Considering Preventative Mastectomy Because of a Strong Family History Of Breast Cancer and Risk Management Options For Women at Increased Risk Of Developing Ovarian Cancer. These materials are available in print and electronic format. Consultation is now underway to produce two decision aids on genetic testing for familial cancer risk. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consumer evidence based practice gene health hereditary tumor EMTREE MEDICAL INDEX TERMS breast cancer cancer genetics cancer risk clinical audit consultation data base education family history female genetic counseling mastectomy ovary cancer patient peer review risk risk management surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70030459 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 415 TITLE Utility of serum HER2 extracellular domain assessment in clinical decision making: Pooled analysis of four trials of trastuzumab in metastatic breast cancer AUTHOR NAMES Leyland-Jones B. Lennon S. Barton C. Banken L. Gianni L. Marty M. Baselga J. AUTHOR ADDRESSES (Leyland-Jones B., LEYLAND@emory.edu; Baselga J.) Winship Cancer Institute, Emory University, School of Medicine, 1701 Uppergate Dr., Atlanta, GA 30322, United States. (Lennon S.; Barton C.; Banken L.; Gianni L.; Marty M.) CORRESPONDENCE ADDRESS B. Leyland-Jones, Winship Cancer Institute, Emory University, School of Medicine, 1701 Uppergate Dr., Atlanta, GA 30322, United States. Email: LEYLAND@emory.edu SOURCE Journal of Clinical Oncology (2009) 27:10 (1685-1693). Date of Publication: 1 Apr 2009 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose Trastuzumab is a humanized monoclonal antibody directed against human epidermal growth factor receptor 2(HER2). Trastuzumab alone or in combination with chemotherapy has been shown to be effective in patients with HER2-positive early and metastatic breast cancer. The extracellular domain(ECD) of the HER2 protein may be shed into the serum and is detectable using an enzyme-linked immunosorbent assay. Correlations have been reported between raised baseline ECD levels and response to trastuzumab, suggesting that serum ECD levels may be useful in making treatment decisions in patients with HER2-positive breast cancer. We investigated this relationship, and also the effect of trastuzumab and chemotherapy on ECD levels, in patients with advanced breast cancer. Methods This study analyzed sequential ECD determinations on 322 patients treated with six different treatment regimens in four clinical trials. Results Baseline values were available in 296 patients, and of these, 205(69%) had raised levels(> 15 ng/mL). No clear relationship was found between baseline ECD levels and tumor response. After initiating combination therapy, ECD levels declined irrespective of treatment received and tumor response. For trastuzumab monotherapy, some trend between changes in ECD levels in early cycles and best response was discernable, but the overlap was too broad to be clinically useful. Disease progression was not reliably predicted by rising ECD levels in the majority of patients. Conclusion Based on our data, we cannot recommend using serum HER2 ECD levels to make trastuzumab or other treatment decisions for individual patients with advanced/metastatic breast cancer. © 2009 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) epidermal growth factor receptor 2 (endogenous compound) trastuzumab (drug combination, drug therapy) EMTREE DRUG INDEX TERMS docetaxel (drug combination, drug therapy) doxorubicin (drug combination, drug therapy) paclitaxel (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy) metastasis (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS advanced cancer (drug therapy) article cancer combination chemotherapy clinical assessment combination chemotherapy controlled study decision making disease course drug effect extracellular matrix female human major clinical study male monotherapy multiple cycle treatment prediction priority journal treatment duration treatment response DRUG TRADE NAMES herceptin , SwitzerlandHoffmann La Roche DRUG MANUFACTURERS (Switzerland)Hoffmann La Roche CAS REGISTRY NUMBERS docetaxel (114977-28-5) doxorubicin (23214-92-8, 25316-40-9) epidermal growth factor receptor 2 (137632-09-8) paclitaxel (33069-62-4) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Clinical and Experimental Biochemistry (29) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009162435 MEDLINE PMID 19255335 (http://www.ncbi.nlm.nih.gov/pubmed/19255335) PUI L354418863 DOI 10.1200/JCO.2008.16.8351 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2008.16.8351 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 416 TITLE Contextual factors in shared decision making: A randomised controlled trial in women with a strong suspicion of breast cancer AUTHOR NAMES Vodermaier A. Caspari C. Koehm J. Kahlert S. Ditsch N. Untch M. AUTHOR ADDRESSES (Vodermaier A., avoderma@psych.ubc.ca; Caspari C.; Koehm J.; Kahlert S.; Ditsch N.) Department of Obstetrics and Gynaecology - Grosshadern, University of Munich, Marchioninistr. 15, Munich 81377, Germany. (Vodermaier A., avoderma@psych.ubc.ca) Department of Psychology, University of British Columbia, West Mall, Vancouver, BC V6T 1Z4, Canada. (Untch M.) Helios Klinikum Berlin Buch, Gynecological Clinic, Breast Cancer Center, Schwanebecker Chaussee 50, Berlin 13125, Germany. CORRESPONDENCE ADDRESS A. Vodermaier, Department of Obstetrics and Gynaecology - Grosshadern, University of Munich, Marchioninistr. 15, Munich 81377, Germany. Email: avoderma@psych.ubc.ca SOURCE British Journal of Cancer (2009) 100:4 (590-597). Date of Publication: 24 Feb 2009 ISSN 0007-0920 1532-1827 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Decision aids in North American breast cancer outpatients have been shown to assist with treatment decision making and reduce decisional conflict. To date, appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer inpatients have not been investigated in the context of German health care provision. The impact of a decision aid intervention was studied in patients (n=111) with a strong suspicion of breast cancer in a randomised controlled trial. The primary outcome variable was decisional conflict. Participants were followed up 1 week post-intervention with a retention rate of 92%. Analyses revealed that the intervention group felt better informed (η(p)(2)=0.06) but did not experience an overall reduction in decisional conflict as compared with the control group. The intervention had no effect on uptake rates of treatment options, length of consultation with the surgeon, time point of treatment decision making, perceived involvement in decision making, neither decision related nor general patient satisfaction. Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options. Results are discussed in terms of contextual factors and individual differences as moderators of treatment decision aid effectiveness. © 2009 Cancer Research UK. EMTREE DRUG INDEX TERMS antineoplastic agent (clinical trial, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS article cancer diagnosis cancer radiotherapy cancer staging cancer surgery clinical trial conflict management control group controlled clinical trial controlled study female health care personnel hormonal therapy hospital patient human human tissue mammography mastectomy medical decision making nuclear magnetic resonance imaging outcome variable partial mastectomy patient participation patient satisfaction priority journal randomized controlled trial tumor volume ultrasound EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009081096 MEDLINE PMID 19209172 (http://www.ncbi.nlm.nih.gov/pubmed/19209172) PUI L50418075 DOI 10.1038/sj.bjc.6604916 FULL TEXT LINK http://dx.doi.org/10.1038/sj.bjc.6604916 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 417 TITLE Can women with early-stage breast cancer make an informed decision for mastectomy? AUTHOR NAMES Collins E.D. Moore C.P. Clay K.F. Kearing S.A. O'Connor A.M. Llewellyn-Thomas H.A. Barth Jr. R.J. Sepucha K.R. AUTHOR ADDRESSES (Collins E.D., e.dale.collins@hitchcock.org) Dartmouth Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, United States. (Moore C.P.; Clay K.F.; Kearing S.A.; O'Connor A.M.; Llewellyn-Thomas H.A.; Barth Jr. R.J.; Sepucha K.R.) CORRESPONDENCE ADDRESS E. D. Collins, Dartmouth Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, United States. Email: e.dale.collins@hitchcock.org SOURCE Journal of Clinical Oncology (2009) 27:4 (519-525). Date of Publication: 1 Feb 2009 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice. Patients and Methods: This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment. Results: Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes ("remove breast for peace of mind," "avoid radiation," and "keep breast") clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation. Conclusion: Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict. © 2008 by American Society of Clinical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer early cancer mastectomy medical decision making patient information EMTREE MEDICAL INDEX TERMS adult article breast surgery cancer radiotherapy cancer recurrence cancer survival conflict consultation controlled study female human major clinical study partial mastectomy priority journal questionnaire recurrence risk EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009054434 MEDLINE PMID 19114703 (http://www.ncbi.nlm.nih.gov/pubmed/19114703) PUI L354133142 DOI 10.1200/JCO.2008.16.6215 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2008.16.6215 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 418 TITLE A perspective on the patient's role in treatment decisions AUTHOR NAMES Sepucha K. Mulley A.G. AUTHOR ADDRESSES (Sepucha K.; Mulley A.G.) Massachusetts General Hospital, United States. SOURCE Medical Care Research and Review (2009) 66:1_suppl (53S-74S). Date of Publication: 1 Feb 2009 ISSN 1552-6801 (electronic) 1077-5587 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT There is considerable evidence, across different clinical contexts, that treatment decisions are characterized by poor communication, significant knowledge gaps, and a lack of attention to patients' preferences for different health states. Over the past two decades, patient decision AIDS have been shown to be an effective means to improve the quality of decisions. More recently, the Internet has increased expectations about the impact of information and decision AIDS on the involvement of patients in decisions. However, there are several challenges to effective dissemination and implementation of decision support interventions, through the Internet or other media. The authors recommend specific policy and research initiatives to facilitate the local and system-level changes necessary to support patients more effectively in making treatment choices. More attention to measurement and policy-level interventions will be required to increase the use of proven tools and to achieve significant improvements in the quality of treatment decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical decision making EMTREE MEDICAL INDEX TERMS breast cancer clinical practice conceptual framework health care cost health care planning health service human Internet intervention study knowledge outcome assessment probability review social support EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Clinical and Experimental Biochemistry (29) Environmental Health and Pollution Control (46) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160803461 PUI L613124461 DOI 10.1177/1077558708325511 FULL TEXT LINK http://dx.doi.org/10.1177/1077558708325511 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 419 TITLE Multidisciplinary Care for Patients with Breast Cancer AUTHOR NAMES Hulvat M.C. Hansen N.M. Jeruss J.S. AUTHOR ADDRESSES (Hulvat M.C.; Hansen N.M.; Jeruss J.S., j-jeruss@northwestern.edu) Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL 60611, United States. (Hulvat M.C.; Hansen N.M.; Jeruss J.S., j-jeruss@northwestern.edu) Lynn Sage Comprehensive Breast Center, 250 E. Superior Street, Prentice 4-420, Chicago, IL 60611, United States. (Hulvat M.C.; Hansen N.M.; Jeruss J.S., j-jeruss@northwestern.edu) Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, United States. CORRESPONDENCE ADDRESS J.S. Jeruss, Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL 60611, United States. Email: j-jeruss@northwestern.edu SOURCE Surgical Clinics of North America (2009) 89:1 (133-176). Date of Publication: February 2009 ISSN 0039-6109 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The care of patients with breast cancer has become increasingly complex with advancements in diagnostic modalities, surgical approaches, and adjuvant treatments. A multidisciplinary approach to breast cancer care is essential to the successful integration of available therapies. This article addresses the key components of multidisciplinary breast cancer care, with a special emphasis on new and emerging approaches over the past 10 years in the fields of diagnostics, surgery, radiation, medical oncology, and plastic surgery. © 2009 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS anastrozole (adverse drug reaction, clinical trial, drug combination, drug comparison, drug therapy, pharmacology) bevacizumab (adverse drug reaction, clinical trial, drug combination, drug therapy, pharmacoeconomics, pharmacology) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) capecitabine (drug combination, drug therapy) carboplatin (clinical trial, drug combination, drug therapy) cisplatin (drug therapy, pharmacology) cyclophosphamide (clinical trial, drug administration, drug combination, drug therapy, intravenous drug administration, oral drug administration) docetaxel (clinical trial, drug combination, drug dose, drug therapy) doxorubicin (clinical trial, drug combination, drug therapy) epidermal growth factor receptor 2 (endogenous compound) erlotinib (drug therapy) exemestane (clinical trial, drug therapy, pharmacology) fluorodeoxyglucose f 18 fluorouracil (drug administration, drug combination, drug therapy, intravenous drug administration, oral drug administration) fulvestrant (drug therapy) geldanamycin (drug therapy) gemcitabine (drug combination, drug therapy) lapatinib (adverse drug reaction, drug combination, drug interaction, drug therapy, oral drug administration, pharmacology) letrozole (clinical trial, drug combination, drug therapy, pharmacology) methotrexate (drug administration, drug combination, drug therapy, intravenous drug administration, oral drug administration) mitomycin (drug therapy, pharmacology) paclitaxel (clinical trial, drug combination, drug dose, drug therapy) pamidronic acid (drug combination, drug therapy) pertuzumab (drug therapy) tamoxifen (adverse drug reaction, clinical trial, drug combination, drug comparison, drug therapy, pharmacology) toremifene (drug therapy) trastuzumab (adverse drug reaction, clinical trial, drug combination, drug interaction, drug therapy, pharmacoeconomics) unindexed drug zoledronic acid (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, drug therapy, epidemiology, etiology, prevention, radiotherapy, surgery) patient care EMTREE MEDICAL INDEX TERMS abdominoplasty adjuvant chemotherapy arthralgia (side effect) axillary lymph node bleeding (side effect) brachytherapy breast endoprosthesis breast examination breast reconstruction cancer adjuvant therapy cancer combination chemotherapy cancer diagnosis cancer hormone therapy cancer immunization cancer patient cancer resistance cancer risk cancer screening cancer staging cancer surgery cancer survival cardiotoxicity (side effect) cerebrovascular accident (side effect) clinical assessment tool clinical trial computer assisted emission tomography congestive heart failure (side effect) decision support system deep vein thrombosis (side effect) dosage schedule comparison drug approval drug mechanism drug potentiation drug substitution drug withdrawal echomammography external beam radiotherapy female fertility fracture (side effect) genetic susceptibility heart infarction (side effect) heart left ventricle ejection fraction human hypertension (side effect) hypertensive crisis (side effect) immunotherapy intestine perforation (side effect) lymph node dissection mammography mastectomy medical decision making metastasis (diagnosis, drug therapy, prevention) monotherapy multimodality cancer therapy multiple cycle treatment nephritis (side effect) nuclear magnetic resonance imaging oncogene partial mastectomy patient assessment patient satisfaction patient selection positron emission tomography practice guideline preoperative care preoperative evaluation priority journal prognosis prophylaxis protein targeting review risk assessment scoring system sensitivity and specificity sentinel lymph node biopsy side effect (side effect) surgical technique therapy effect thrombosis (side effect) transverse rectus abdominis musculocutaneous flap treatment indication treatment outcome unspecified side effect (side effect) uterus cancer (side effect) venous thromboembolism (side effect) wound healing (side effect) DRUG TRADE NAMES arimidex avastin Genentech herceptin Genentech tykerb Glaxo SmithKline DRUG MANUFACTURERS Genentech Glaxo SmithKline DEVICE TRADE NAMES Alloderm , United StatesLifecell GeneSearch Veridex Mammoprint Agendia Oncotype DX , United StatesGenomic Health DEVICE MANUFACTURERS Agendia (United States)Genomic Health (United States)Lifecell Veridex CAS REGISTRY NUMBERS anastrozole (120511-73-1) bevacizumab (216974-75-3) capecitabine (154361-50-9) carboplatin (41575-94-4) cisplatin (15663-27-1, 26035-31-4, 96081-74-2) cyclophosphamide (50-18-0) docetaxel (114977-28-5) doxorubicin (23214-92-8, 25316-40-9) epidermal growth factor receptor 2 (137632-09-8) erlotinib (183319-69-9, 183321-74-6) exemestane (107868-30-4) fluorodeoxyglucose f 18 (63503-12-8) fluorouracil (51-21-8) fulvestrant (129453-61-8) geldanamycin (30562-34-6) gemcitabine (103882-84-4) lapatinib (231277-92-2, 388082-78-8, 437755-78-7) letrozole (112809-51-5) methotrexate (15475-56-6, 59-05-2, 7413-34-5) mitomycin C (50-07-7, 74349-48-7) paclitaxel (33069-62-4) pamidronic acid (40391-99-9, 57248-88-1) tamoxifen (10540-29-1) toremifene (89778-26-7) trastuzumab (180288-69-1) zoledronic acid (118072-93-8, 131654-46-1, 165800-06-6, 165800-07-7) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009044740 MEDLINE PMID 19186235 (http://www.ncbi.nlm.nih.gov/pubmed/19186235) PUI L354109579 DOI 10.1016/j.suc.2008.10.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.suc.2008.10.002 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 420 TITLE Randomized Trial of a Decision Aid for BRCA1/BRCA2 Mutation Carriers: Impact on Measures of Decision Making and Satisfaction AUTHOR NAMES Schwartz M.D. Valdimarsdottir H.B. DeMarco T.A. Peshkin B.N. Lawrence W. Rispoli J. Brown K. Isaacs C. O'Neill S. Shelby R. Grumet S.C. McGovern M.M. Garnett S. Bremer H. Leaman S. O'Mara K. Kelleher S. Komaridis K. AUTHOR ADDRESSES (Schwartz M.D., schwartm@georgetown.edu; DeMarco T.A.; Peshkin B.N.; Lawrence W.; Isaacs C.; Garnett S.; Bremer H.; Leaman S.; O'Mara K.; Kelleher S.; Komaridis K.) Cancer Control Program, Fisher Center for Familial Cancer Research, Department of Oncology, . (Valdimarsdottir H.B.) Department of Oncological Sciences, Mount Sinai School of Medicine, . (Rispoli J.; Brown K.; McGovern M.M.) Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, . (O'Neill S.) Social and Behavioral Research Branch, NHGRI, NIH, . (Shelby R.) Department of Psychiatry and Behavioral Sciences, Duke University, . (Grumet S.C.) Englewood Hospital, Medical Center, . CORRESPONDENCE ADDRESS M.D. Schwartz, Cancer Control Program, Fisher Center for Familial Cancer Research, Department of Oncology, . Email: schwartm@georgetown.edu SOURCE Health Psychology (2009) 28:1 (11-19). Date of Publication: January 2009 ISSN 0278-6133 BOOK PUBLISHER American Psychological Association Inc., 750 First Street NE, Washington, United States. ABSTRACT Objective: Genetic testing is increasingly part of routine clinical care for women with a family history of breast cancer. Given their substantially elevated risk for breast cancer, BRCA1/BRCA2 mutation carriers must make the difficult decision whether or not to opt for risk reducing mastectomy. To help BRCA1/2 carriers make this decision, the authors developed a computer-based interactive decision aid that was tested against usual care in a randomized controlled trial. Design: After the completion of genetic counseling, 214 female (aged 21-75) BRCA1/BRCA2 mutation carriers were randomized to Usual Care (UC; N = 114) or Usual Care plus Decision Aid (DA; N = 100) arms. UC participants received no additional intervention. DA participants were sent the CD-ROM DA to view at home. Main Outcome Measures: The authors measured final management decision, decisional conflict, decisional satisfaction, and receipt of risk reducing mastectomy at 1-, 6-, and 12-months postrandomization. Results: Longitudinal analyses revealed that the DA was effective among carriers who were initially undecided about how to manage their breast cancer risk. Within this group, the DA led to an increased likelihood of reaching a management decision (OR = 3.09, 95% CI = 1.62, 5.90; p < .001), decreased decisional conflict (B = -.46, z = -3.1, p <.002), and increased satisfaction (B = .27, z = 3.1, p = .002) compared to UC. Among carriers who had already made a management decision by the time of randomization, the DA had no benefit relative to UC. Conclusion: These results demonstrate that BRCA1/BRCA2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from adjunct decision support. © 2009 American Psychological Association. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making mastectomy mutation risk satisfaction EMTREE MEDICAL INDEX TERMS arm breast cancer cancer risk computer decision support system family history female genetic counseling genetic screening randomization randomized controlled trial risk management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009044717 MEDLINE PMID 19210013 (http://www.ncbi.nlm.nih.gov/pubmed/19210013) PUI L354109573 DOI 10.1037/a0013147 FULL TEXT LINK http://dx.doi.org/10.1037/a0013147 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 421 TITLE Women's constructions of the “right time” to consider decisions about prophylactic surgery AUTHOR NAMES Howard A.F. Bottorff J.L. Balneaves L.G. AUTHOR ADDRESSES (Howard A.F.; Balneaves L.G.) University of British Columbia, Vancouver, Canada. (Bottorff J.L.) University of British Columbia, Kelowna, Canada. CORRESPONDENCE ADDRESS A.F. Howard, University of British Columbia, Vancouver, Canada. SOURCE Current Oncology (2009) 16:5 (109). Date of Publication: 2009 CONFERENCE NAME 3rd International Symposium on Hereditary Breast and Ovarian Cancer CONFERENCE LOCATION Montreal, QC, Canada CONFERENCE DATE 2009-10-14 to 2009-10-16 ISSN 1198-0052 BOOK PUBLISHER Multimed Inc. ABSTRACT Women who are notified that they carry a BRCA1/2 mutation are presented with surgical options to reduce their risk of breast and ovarian cancer, including risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). There is growing evidence that a subgroup of women do not make decisions about RRM and RRO immediately following genetic testing; rather, they consider these decisions years later. Women's perspectives on the timing of these decisions are not well understood. Accordingly, the purpose of this study was to describe how women construct the “right time” to consider decisions about RRM and RRO. In-depth interviews were conducted with 21 women who were BRCA1/2 carriers and were analyzed using qualitative, constant comparative methods. The study findings revealed how important it was for the women to make decisions about RRM and RRO one at a time. Moreover, the women constructed the “right time” to consider decisions about risk-reducing surgery to be when • decisions fit into their lives, • they had enough time to think about decisions, • they were ready emotionally to deal with decisions, • all of the issues and conflicts were sorted out, • there were better options available, and • the health care system was ready for them. These findings offer novel insights relevant to health care professionals who provide decision support to women considering RRM and RRO0 decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast female ovary cancer surgery EMTREE MEDICAL INDEX TERMS constant comparative method decision support system genetic screening health care personnel health care system interview mastectomy mutation ovariectomy risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70048161 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 422 TITLE Evidence Based Medicine and Shared Decision Making: The challenge of getting both evidence and preferences into health care AUTHOR NAMES Barratt A. AUTHOR ADDRESSES (Barratt A., alexb@health.usyd.edu.au) School of Public Health, University of Sydney, Sydney, NSW 2006, Australia. CORRESPONDENCE ADDRESS A. Barratt, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia. Email: alexb@health.usyd.edu.au SOURCE Patient Education and Counseling (2008) 73:3 (407-412). Date of Publication: December 2008 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Evidence Based Medicine (EBM) and Shared Medical Decision Making (SDM) are changing the nature of health care decisions. It is broadly accepted that health care decisions require the integration of research evidence and individual preferences. These approaches are justified on both efficacy grounds (that evidence based practice and Shared Decision Making should lead to better health outcomes and may lead to a more cost-effective use of health care resources) and ethical grounds (patients' autonomy should be respected in health care). However, despite endorsement by physicians and consumers of these approaches, implementation remains limited in practice, particularly outside academic and tertiary health care centres. There are practical problems of implementation, which include training, access to research, and development of and access to tools to display evidence and support decision making. There may also be philosophical difficulties, and some have even suggested that the two approaches (evidence based practice and Shared Decision Making) are fundamentally incompatible. This paper look at the achievements of EBM and SDM so far, the potential tensions between them, and how things might progress in the future. © 2008. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care patient care EMTREE MEDICAL INDEX TERMS article breast cancer decision making depression evidence based medicine health care personnel hormone substitution human medical practice priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008536409 MEDLINE PMID 18845414 (http://www.ncbi.nlm.nih.gov/pubmed/18845414) PUI L50293618 DOI 10.1016/j.pec.2008.07.054 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2008.07.054 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 423 TITLE Toward decision support for breast reconstruction: automated calculation of symmetry measure on clinical photographs. AUTHOR NAMES Dabeer M. Kyrish M. Kim M.S. Reyes P. Udpa N. Reece G.P. Markey M.K. AUTHOR ADDRESSES (Dabeer M.; Kyrish M.; Kim M.S.; Reyes P.; Udpa N.; Reece G.P.; Markey M.K.) University of Texas, Department of Biomedical Engineering, Austin, TX, USA. CORRESPONDENCE ADDRESS M. Dabeer, University of Texas, Department of Biomedical Engineering, Austin, TX, USA. SOURCE AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium (2008) (1045). Date of Publication: 2008 ISSN 1942-597X (electronic) ABSTRACT The quality of life of breast cancer survivors is maintained by minimizing adverse effects on their physical appearance. In this study, we present an automated method for computing a common measure of breast symmetry, the normalized Breast Retraction Assessment (pBRA), from routine clinical photographs taken to document breast reconstruction procedures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) automated pattern recognition breast (surgery) computer assisted diagnosis computer assisted surgery decision support system mastectomy photography EMTREE MEDICAL INDEX TERMS article female human methodology pathology plastic surgery LANGUAGE OF ARTICLE English MEDLINE PMID 18999286 (http://www.ncbi.nlm.nih.gov/pubmed/18999286) PUI L550289222 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 424 TITLE Can people find patient decision aids on the Internet? AUTHOR NAMES Morris D. Drake E. Saarimaki A. Bennett C. O'Connor A. AUTHOR ADDRESSES (Morris D., dmorris@ohri.ca; Drake E.; Saarimaki A.; Bennett C.; O'Connor A.) Ottawa Health Research Institute, Ottawa, Canada. (Drake E.; O'Connor A.) University of Ottawa, Ottawa, Canada. CORRESPONDENCE ADDRESS D. Morris, Ottawa Health Research Institute, Ottawa, Canada. Email: dmorris@ohri.ca SOURCE Patient Education and Counseling (2008) 73:3 (557-560). Date of Publication: December 2008 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To determine if people could find patient decision aids (PtDAs) on the Internet using the most popular general search engines. Methods: We chose five medical conditions for which English language PtDAs were available from at least three different developers. The search engines used were: Google (www.google.com), Yahoo! (www.yahoo.com), and MSN (www.msn.com). For each condition and search engine we ran six searches using a combination of search terms. We coded all non-sponsored Web pages that were linked from the first page of the search results. Results: Most first page results linked to informational Web pages about the condition, only 16% linked to PtDAs. PtDAs were more readily found for the breast cancer surgery decision (our searches found seven of the nine developers). The searches using Yahoo and Google search engines were more likely to find PtDAs. The following combination of search terms: condition, treatment, decision (e.g. breast cancer surgery decision) was most successful across all search engines (29%). Conclusion: While some terms and search engines were more successful, few resulted in direct links to PtDAs. Practice implications: Finding PtDAs would be improved with use of standardized labelling, providing patients with specific Web site addresses or access to an independent PtDA clearinghouse. © 2008 Elsevier Ireland Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient decision making EMTREE MEDICAL INDEX TERMS article controlled study human Internet medical information medical information system patient care priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008536427 MEDLINE PMID 18789628 (http://www.ncbi.nlm.nih.gov/pubmed/18789628) PUI L50267727 DOI 10.1016/j.pec.2008.07.046 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2008.07.046 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 425 TITLE Treatment decision making among chinese women with DCIS AUTHOR NAMES Wong S.T. Chen W. Bottorff J.L. Hislop T.G. AUTHOR ADDRESSES (Wong S.T., sabrina.wong@nursing.ubc.ca; Chen W.) University of British Columbia, School of Nursing, Culture, Gender, Centre for Health Services and Policy Research, Vancouver, BC V6T-2B5, Canada. (Wong S.T., sabrina.wong@nursing.ubc.ca) University of British Columbia, Centre ForHealth Services and Policy Research, Vancouver, BC, Canada. (Bottorff J.L.) University of British Columbia Okanagan, Faculty of Health and Social Development, Kelowna, Canada. (Hislop T.G.) BritishColumbia Cancer Agency, Vancouver, BC, Canada. CORRESPONDENCE ADDRESS S. T. Wong, University of British Columbia, School of Nursing, Culture, Gender, Centre for Health Services and Policy Research, Vancouver, BC V6T-2B5, Canada. Email: sabrina.wong@nursing.ubc.ca SOURCE Journal of Psychosocial Oncology (2008) 26:4 (53-73). Date of Publication: 3 Oct 2008 ISSN 0734-7332 1540-7586 (electronic) BOOK PUBLISHER Routledge, 325 Chestnut Street, Philadelphia, United States. ABSTRACT One result of the widespread screening mammography is a 200% increase in the rates of breast ductal carcinoma in situ (DCIS). Treatment decision making among Chinese women diagnosed with DCIS remains understudied. This study examined Chinese-Canadian women's experiences (N = 26): (1) with treatment decision making (mastectomy or breast conserving surgery) and (2) their reflections on the decision-making process. Interviews in Cantonese, Mandarin, or English were transcribed and translated, and a content analysis conducted. Women's treatment decisions reflected a lack of understanding of DCIS, the desire to rid themselves of breast cancer forever, and the influence of significant others. English as a second language and use of medical jargon impeded their ability to make informed treatment decisions. Women's reflections on the decision-making process provided insights into how to improve information and support treatment decision making in ways that are accessible to them. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical decision making intraductal carcinoma (diagnosis, surgery) partial mastectomy EMTREE MEDICAL INDEX TERMS adult aged article Canada Chinese clinical article comprehension content analysis experience female human information interview introspection language population EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009596827 MEDLINE PMID 19042272 (http://www.ncbi.nlm.nih.gov/pubmed/19042272) PUI L355647832 DOI 10.1080/07347330802359594 FULL TEXT LINK http://dx.doi.org/10.1080/07347330802359594 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 426 TITLE Interactive digital education aid in breast reconstruction? AUTHOR NAMES Heller L. Parker P.A. Youssef A. Miller M.J. AUTHOR ADDRESSES (Heller L., lheller@bcm.edu; Parker P.A.; Youssef A.; Miller M.J.) Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1709 Dryden, Houston, TX 77030. CORRESPONDENCE ADDRESS L. Heller, Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1709 Dryden, Houston, TX 77030. Email: lheller@bcm.edu SOURCE Plastic and Reconstructive Surgery (2008) 122:3 (717-724). Date of Publication: September 2008 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT BACKGROUND: An interactive digital education aid for breast reconstruction patients was developed because of a perceived need to provide patients with more education regarding the treatment so that they can make better informed treatment decisions. A prospective randomized study was conducted to assess its effectiveness. METHODS: Breast cancer patients who were candidates for breast reconstruction were recruited and randomized into a control group and a study group. Both groups received routine assessment and education in the plastic surgery clinic, but the study group also watched the interactive digital education aid. Questionnaires assessing knowledge, anxiety, and satisfaction were administered (1) before the initial plastic surgery consultation, (2) immediately before surgery, and (3) 1 month after surgery. RESULTS: A total of 133 women participated, 66 in the control group and 67 in the study group. Women in both groups showed decreased anxiety, increased knowledge, and enhanced satisfaction with their decision-making ability associated with preoperative instructions about reconstructive surgery. However, the study group was significantly more satisfied than the control group with the method of receiving information and showed a less steep learning curve regarding the different techniques of breast reconstruction. They also tended to have a reduced mean level of anxiety and increased satisfaction with the treatment choice compared with the control group. CONCLUSIONS: An interactive digital education aid is a beneficial educational adjunct for patients contemplating breast reconstruction. Patients who use an interactive digital education aid demonstrate greater factual knowledge, reduced anxiety, and increased postoperative satisfaction compared with patients given preoperative instructions using standard methods alone. The benefit of an interactive digital education aid is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center. Copyright © 2008 by the American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction educational technology interactive digital education aid EMTREE MEDICAL INDEX TERMS anxiety article breast cancer (surgery) cancer patient cancer surgery clinical assessment consultation controlled study female health education human knowledge learning major clinical study medical decision making medical information patient education patient satisfaction plastic surgery preoperative care priority journal prospective study questionnaire software EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009388419 MEDLINE PMID 18766034 (http://www.ncbi.nlm.nih.gov/pubmed/18766034) PUI L355000702 DOI 10.1097/PRS.0b013e318180ed06 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e318180ed06 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 427 TITLE Support needs and acceptability of psychological and peer consultation: Attitudes of 108 women who had undergone or were considering prophylactic mastectomy AUTHOR NAMES Patenaude A.F. Orozco S. Li X. Kaelin C.M. Gadd M. Matory Y. Mayzel K. Roche C.A. Smith B.L. Farkas W. Garber J.E. AUTHOR ADDRESSES (Patenaude A.F., andrea_patenaude@dfci.harvard.edu; Orozco S.) Department of Pediatric Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, United States. (Li X.) Department of Biostatistics, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, United States. (Kaelin C.M.; Matory Y.) Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States. (Gadd M.; Smith B.L.) Department of Surgery, Massachusetts General Hospital, Boston, MA, United States. (Mayzel K.) Department of Surgery, Faulkner Hospital, Boston, MA, United States. (Roche C.A.) Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA, United States. (Farkas W.) Brigham and Women's Hospital, Boston, MA, United States. (Garber J.E.) Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, United States. CORRESPONDENCE ADDRESS A.F. Patenaude, Department of Pediatric Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, United States. Email: andrea_patenaude@dfci.harvard.edu SOURCE Psycho-Oncology (2008) 17:8 (831-843). Date of Publication: August 2008 ISSN 1057-9249 1099-1611 (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Objective: Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America is low (0-27%) and 25-50% of women electing surgery report psychological distress and/or difficulty adapting following PM. Most women also report reduced cancer worry postoperatively. Psychological consultation to aid decision-making and post-surgical coping is not routinely offered. This retrospective, cross-sectional study explored interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery. Method: Qualitative interviews were conducted with 26 healthy women who had undergone prophylactic mastectomy of both (bilateral) breasts (BPM), 45 women who had undergone prophylactic mastectomy of one breast (unilateral contralateral) (UPM) after diagnosis of invasive breast cancer in the other breast or ductal carcinoma in situ (DCIS), and 37 women who were considering having PM surgery. Results: Of the women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable; nearly 2/3 thought post-surgical psychological consultation would be helpful. All women currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Strong support was reported in all groups for the emotional and informational value of speaking with a woman who had previously undergone PM. Conclusions: Narratives illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for integration of psychological services for women deciding about or adapting to PM. Copyright © 2008 John Wiley & Sons, Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (prevention, surgery, therapy) mastectomy psychosocial care EMTREE MEDICAL INDEX TERMS adult aged article cancer risk clinical decision making consultation controlled study female health care delivery human intraductal carcinoma (prevention, surgery, therapy) major clinical study outcome assessment patient attitude patient counseling peer group preoperative care psychotherapy qualitative research retrospective study risk reduction EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008433339 MEDLINE PMID 18636423 (http://www.ncbi.nlm.nih.gov/pubmed/18636423) PUI L352336300 DOI 10.1002/pon.1279 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1279 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 428 TITLE Report on the sixth scientific meeting of the Australasian Society for Breast Disease (ASBD) AUTHOR NAMES Houssami N. AUTHOR ADDRESSES (Houssami N., nehmath@med.usyd.edu.au) University of Sydney, Sydney, NSW 2006, Australia. CORRESPONDENCE ADDRESS N. Houssami, University of Sydney, Sydney, NSW 2006, Australia. Email: nehmath@med.usyd.edu.au SOURCE Breast (2008) 17:2 (205). Date of Publication: April 2008 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) hormone receptor (endogenous compound) monoclonal antibody EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, drug therapy, prevention, radiotherapy, surgery) cancer research medical education EMTREE MEDICAL INDEX TERMS Asia Australia breast biopsy breast carcinogenesis breast reconstruction cancer chemotherapy cancer classification cancer localization cancer mortality cancer palliative therapy cancer prevention cancer radiotherapy cancer risk cancer screening clinical decision making conference paper decision support system diagnostic error early cancer (diagnosis, drug therapy, etiology, prevention, radiotherapy, surgery) echography gene expression profiling histopathology human interdisciplinary communication intraoperative period mammography mastectomy medical society metastasis potential nursing education postoperative care pregnancy priority journal prognosis quality of life risk benefit analysis risk management surgeon surgical training systemic therapy treatment outcome women's health workshop EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008160696 MEDLINE PMID 18083029 (http://www.ncbi.nlm.nih.gov/pubmed/18083029) PUI L50015537 DOI 10.1016/j.breast.2007.11.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2007.11.003 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 429 TITLE Implementing breast cancer decision aids in community sites: Barriers and resources AUTHOR NAMES Silvia K.A. Ozanne E.M. Sepucha K.R. AUTHOR ADDRESSES (Sepucha K.R., ksepucha@partners.org) Health Decision Research Unit, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States. (Silvia K.A.) Suffolk University, Boston, MA, United States. (Ozanne E.M.) Massachusetts General Hospital Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, United States. (Sepucha K.R., ksepucha@partners.org) Health Decision Research Unit, Massachusetts General Hospital, Boston, MA, United States. CORRESPONDENCE ADDRESS K.R. Sepucha, Health Decision Research Unit, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, United States. Email: ksepucha@partners.org SOURCE Health Expectations (2008) 11:1 (46-53). Date of Publication: March 2008 ISSN 1369-6513 1369-7625 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Objective: To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. Background: There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. Design: Structured individual interviews. Setting and participants: Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. Main outcome measures: Usage data, barriers to and resources for implementing the PtDAs. Results: Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign-out system. The keys to successful implementation included nurses' and social workers' interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses' perceptions about patients' attitude towards participation in decision making. Conclusions: It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available. © 2008 The Authors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer decision support system EMTREE MEDICAL INDEX TERMS article clinical practice community care community hospital early cancer health personnel attitude human medical decision making nurse patient attitude patient participation priority journal social worker EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008079291 MEDLINE PMID 18275401 (http://www.ncbi.nlm.nih.gov/pubmed/18275401) PUI L351239423 DOI 10.1111/j.1369-7625.2007.00477.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1369-7625.2007.00477.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 430 TITLE Interactive patient decision aids for women facing genetic testing for familial breast cancer: A systematic web and literature review AUTHOR NAMES Williams L. Jones W. Elwyn G. Edwards A. AUTHOR ADDRESSES (Williams L.; Elwyn G.; Edwards A., edwardsag@cardiff.ac.uk) Department of General Practice, School of Medicine, Cardiff University, Cardiff, United Kingdom. (Jones W.) School of Medicine, University of Swansea, Swansea, United Kingdom. (Jones W.) Department of Cancer Genetics, Singleton Hospital, Swansea, United Kingdom. (Edwards A., edwardsag@cardiff.ac.uk) Department of General Practice, School of Medicine, Cardiff University, Neuadd Meirionnydd Heath Park, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS A. Edwards, Department of General Practice, School of Medicine, Cardiff University, Neuadd Meirionnydd Heath Park, Cardiff CF14 4XN, United Kingdom. Email: edwardsag@cardiff.ac.uk SOURCE Journal of Evaluation in Clinical Practice (2008) 14:1 (70-74). Date of Publication: February 2008 ISSN 1356-1294 1365-2753 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Objective: A systematic review to identify and appraise interactive decision aids that are designed for consumer use, in the field of hereditary breast cancer and genetic testing. Methods: An Internet (Google, Alta Vista) and literature search (Medline) was conducted for suitable decision aids. The decision aid had to (inclusion criteria): be about genetic testing for familial breast cancer; fulfil the criteria of a decision aid; use multimedia IT; be interactive (user does something that influences the decision pathway); and be for patient/public use. Exclusion criteria were decision aids that: had no interactivity (e.g. leaflet, video); discussed management decisions after gene status confirmed; non-English; aids that required membership/subscription. Once aids had been selected for further appraisal they were assessed against a recognized framework for the evaluation of decision aids - the International Patient Decision Aid Standards (IPDAS) criteria. Results: On Google 595 web pages were assessed, as were 382 Google directory entries. Alta Vista revealed fewer results and revealed no new sites. Twenty-four web sites and four CD-ROMs with the most potential as stand alone decision aids were then selected for further assessment. On Medline 776 citations were reviewed, of these only one CD-ROM and no web sites were found. After initial appraisal only two CD-ROMs and one web site met the criteria for further consideration. Assessed against the IPDAS criteria, the decision aids scored poorly with no aid scoring more than 50%. Conclusions: Although there is a significant amount of interest in genetic testing to determine whether a woman is at high risk of breast cancer, the current genetic services are having difficulty coping with the demand. Alternatives such as decision aids have been suggested. There are many sources of information available, but few are truly interactive or designed for patient use. Of the three evaluated, all were from the USA and are likely to require modification for patients elsewhere. © 2008 The Authors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis) genetic analysis patient decision making EMTREE MEDICAL INDEX TERMS article cancer risk clinical trial compact disk consumer genetic service hereditary tumor (diagnosis) human Internet medical information medical literature Medline priority journal systematic review United States EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008033809 MEDLINE PMID 18211647 (http://www.ncbi.nlm.nih.gov/pubmed/18211647) PUI L351115217 DOI 10.1111/j.1365-2753.2007.00798.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2753.2007.00798.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 431 TITLE Exploring the requirements for a decision aid on familial breast cancer in the UK context: A qualitative study with patients referred to a cancer genetics service AUTHOR NAMES Iredale R. Rapport F. Sivell S. Jones W. Edwards A. Gray J. Elwyn G. AUTHOR ADDRESSES (Iredale R., Rachel.Iredale@cardiffandvale.wales.nhs.uk; Sivell S.) Institute of Medical Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom. (Gray J.) Department of Medical Genetics, Institute of Medical Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom. (Rapport F.; Jones W.) School of Medicine, Swansea University, Swansea, United Kingdom. (Edwards A.) Department of General Practice, Centre for Health Sciences Research, Cardiff University School of Medicine, Cardiff, United Kingdom. (Elwyn G.) Department of Primary Care Research, Centre for Health Sciences Research, Cardiff University School of Medicine, Cardiff, United Kingdom. (Iredale R., Rachel.Iredale@cardiffandvale.wales.nhs.uk) Institute of Medical Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS R. Iredale, Institute of Medical Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, United Kingdom. Email: Rachel.Iredale@cardiffandvale.wales.nhs.uk SOURCE Journal of Evaluation in Clinical Practice (2008) 14:1 (110-115). Date of Publication: February 2008 ISSN 1356-1294 1365-2753 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Rationale: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK. Methods: Focus groups were held with 39 women over 18 years of age referred to a cancer genetics clinic, and who had been given a risk assessment for developing breast cancer. Each focus group examined three existing North American decision aids (1 paper-based and 2 CD-ROMs) and explored what a decision aid in a UK context should look like and the information it should contain. Results: There was enthusiasm for the development of decision aids that suit the local context in terms of its health care policy, in paper-based and CD-ROM formats. This paper identifies areas of agreement and disagreement in terms of both content and presentation styles, and also reports some of the suggestions received about where, when and with whom decision aids should be used. Participants suggested that decision aids would be most effective when they allowed a user-selected range of formats. Conclusion: There is still significant unmet demand for information and decision support in the context of publicly funded health care. The patient perspective provides a unique insight into issues of design, style and communication. © 2008 The Authors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer hereditary tumor patient decision making EMTREE MEDICAL INDEX TERMS adult article cancer genetics cancer risk cancer screening cancer susceptibility cancer therapy clinical article female health care policy human priority journal qualitative research risk assessment United Kingdom EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008033815 MEDLINE PMID 18211652 (http://www.ncbi.nlm.nih.gov/pubmed/18211652) PUI L351115223 DOI 10.1111/j.1365-2753.2007.00811.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2753.2007.00811.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 432 TITLE Regret associated with the decision for breast reconstruction: The association of negative body image, distress and surgery characteristics with decision regret AUTHOR NAMES Sheehan J. Sherman K.A. Lam T. Boyages J. AUTHOR ADDRESSES (Sheehan J., Kerry.Sherman@psy.mq.edu.au; Sherman K.A.) Department of Psychology, Macquarie University, NSW 2109, Australia. (Sherman K.A.; Lam T.; Boyages J.) NSW Breast Cancer Institute, Westmead Hospital, Westmead, NSW 2145, Australia. CORRESPONDENCE ADDRESS J. Sheehan, Email: Kerry.Sherman@psy.mq.edu.au SOURCE Psychology and Health (2008) 23:2 (207-219). Date of Publication: February 2008 ISSN 1476-8321 (electronic) 0887-0446 ABSTRACT This study investigated the influence of psychosocial and surgical factors on decision regret among 123 women diagnosed with breast cancer who had undergone immediate (58%) or delayed (42%) breast reconstruction following mastectomy. The majority of participants (52.8%, n = 65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with negative body image and psychological distress - intrusion and avoidance. There were no differences in decision regret either with respect to methods or timing patterns of reconstructive surgery. Multinominal logistic regression analysis showed that, when controlling for mood state and time since last reconstructive procedure, increases in negative body image were associated with increased likelihood of experiencing decision regret. These findings highlight the need for optimal input from surgeons and therapists in order to promote realistic expectations regarding the outcome of breast reconstruction and to reduce the likelihood of women experiencing decision regret. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction decision making emotion EMTREE MEDICAL INDEX TERMS adult aged article body image breast tumor (surgery) decision regret female human intrusion and avoidance mastectomy mental stress middle aged negative body image psychological aspect questionnaire very elderly young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25160051 (http://www.ncbi.nlm.nih.gov/pubmed/25160051) PUI L1351044312 DOI 10.1080/14768320601124899 FULL TEXT LINK http://dx.doi.org/10.1080/14768320601124899 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 433 TITLE Basal breast cancer molecular subtype predicts for lower incidence of axillary lymph node metastases in primary breast cancer AUTHOR NAMES Crabb S.J. Cheang M.C.U. Leung S. Immonen T. Nielsen T.O. Huntsman D.D. Bajdik C.D. Chia S.K. AUTHOR ADDRESSES (Crabb S.J.; Chia S.K., schia@bccancer.bc.ca) Division of Medical Oncology, . (Cheang M.C.U.; Leung S.; Nielsen T.O.; Huntsman D.D.) Genetic Pathology Evaluation Centre, . (Immonen T.; Bajdik C.D.) Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, BC, Canada. (Chia S.K., schia@bccancer.bc.ca) FRCP, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada. CORRESPONDENCE ADDRESS S. K. Chia, FRCP, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada. Email: schia@bccancer.bc.ca SOURCE Clinical Breast Cancer (2008) 8:3 (249-256). Date of Publication: June 2008 ISSN 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background: Axillary lymph node involvement remains the most important prognostic factor in early-stage breast cancer. We hypothesized that molecular classification based on breast cancer biology would predict the presence of nodal involvement at diagnosis, which might aid treatment decisions regarding the axilla. Patients and Methods: From a clinically annotated tissue microarray of 4444 early-stage breast cancers, expression of estrogen receptor (ER), progesterone receptor (PgR), HER2, epidermal growth factor receptor, and cytokeratin 5/6 was determined by immunohistochemistry. Cases were classified by published criteria into molecular subtypes of luminal, luminal/HER2 positive, HER2 positive/ER negative/PgR negative, and basal. Risk of axillary nodal involvement at diagnosis was determined in 2 multivariable logistic regression models: a "core biopsy model" including molecular subtype, age, grade, and tumor size and a "lumpectomy model," which also included lymphovascular invasion. Luminal was used as the reference group. After internal validation of findings in 2 independent sets, we conducted combined analysis of both. Results: In the core biopsy model, the molecular subtypes had a predictive effect for nodal involvement (P = .000001), with the basal subtype having an odds ratio for axillary lymph node involvement of 0.53 (95% CI, 0.41 -0.69). Tumor grade (P = 5.43 × 10(-12)) and size (P = 8.52 × 10(-35)) were also predictive for nodal involvement. Similar results were found in the lumpectomy model, where lymphovascular invasion was also predictive (P = 2.74 × 1C(-15)). Conclusion: These results indicate that the basal breast cancer molecular subtype predicts a lower incidence of axillary nodal involvement, and including biomarker profiles to predict nodal status at diagnosis could help stratification for decisions regarding axillary surgery and locoregional radiation. EMTREE DRUG INDEX TERMS biological marker (endogenous compound) cytokeratin 5 (endogenous compound) cytokeratin 6 (endogenous compound) epidermal growth factor receptor 2 (endogenous compound) estrogen receptor (endogenous compound) progesterone receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) axillary lymph node breast cancer (diagnosis, etiology) lymph node metastasis (complication) EMTREE MEDICAL INDEX TERMS adult aged article cancer grading cancer staging early cancer female gene expression human human tissue immunohistochemistry incidence lymph node biopsy major clinical study medical decision making multivariate logistic regression analysis partial mastectomy prognosis tissue microarray tumor invasion (complication) tumor volume validation process CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) EMBASE CLASSIFICATIONS Cancer (16) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008330962 MEDLINE PMID 18650155 (http://www.ncbi.nlm.nih.gov/pubmed/18650155) PUI L351962146 DOI 10.3816/CBC.2008.n.028 FULL TEXT LINK http://dx.doi.org/10.3816/CBC.2008.n.028 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 434 TITLE Decision analysis to assess the efficacy of routine sentinel lymphadenectomy in patients undergoing prophylactic mastectomy AUTHOR NAMES Boughey J.C. Cormier J.N. Xing Y. Hunt K.K. Meric-Bernstam F. Babiera G.V. Ross M.I. Kuerer H.M. Singletary S.E. Bedrosian I. AUTHOR ADDRESSES (Boughey J.C.; Cormier J.N.; Xing Y.; Hunt K.K.; Meric-Bernstam F.; Babiera G.V.; Ross M.I.; Kuerer H.M.; Singletary S.E.; Bedrosian I., ibedrosian@mdanderson.org) Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Bedrosian I., ibedrosian@mdanderson.org) Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, TX 77230-1402, United States. CORRESPONDENCE ADDRESS I. Bedrosian, Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, TX 77230-1402, United States. Email: ibedrosian@mdanderson.org SOURCE Cancer (2007) 110:11 (2542-2550). Date of Publication: 1 Dec 2007 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. Patients who have invasive breast cancer identified after prophylactic mastectomy (PM) require axillary lymph node dissection (ALND) for lymph node staging (ie, directed ALND). Because the majority of these patients will be lymph node negative, sentinel lymphadenectomy (SLND) has been advocated at the time of PM to avoid the sequelae of unnecessary ALND. The objective of this study was to compare the efficacy of 2 surgical strategies, routine SLND versus directed ALND, in PM patients. METHODS. A decision-analytic model was created to compare the 2 surgical strategies. Model estimates were derived from a systematic literature review. The endpoints that were examined to compare the 2 strategies were the number of SLNDs performed per breast cancer detected, the number of SLNDs attempted to avoid 1 ALND in a lymph node-negative patient with occult invasive cancer, and the number of axillary complications associated with each strategy. RESULTS. The prevalence of invasive cancer in patients undergoing PM was estimated at 1.9%. At this rate, 37 SLNDs were performed per 1 breast cancer detected, and 73 SLNDs were required to avoid 1 ALND in a lymph node-negative PM patient. In 1 model scenario, the probability of complications per breast cancer detected was 9-fold greater with the SLND strategy than with the directed ALND strategy (2.7 vs 0.3). The complication rates for the 2 strategies become equivalent in the model scenario when the prevalence of occult invasive cancer was projected to 28%. CONCLUSIONS. Routine SLND for patients undergoing PM is not warranted given the large number of procedures required to benefit 1 patient and the potential complications associated with performing SLND in all patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (epidemiology, prevention, surgery) lymph node dissection lymph node dissection EMTREE MEDICAL INDEX TERMS article axillary lymph node cancer diagnosis cancer staging decision making female human intermethod comparison lymphedema (complication) major clinical study mastectomy paresthesia (complication) prevalence priority journal prophylaxis sentinel lymph node systematic review tumor invasion EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007577499 MEDLINE PMID 17932905 (http://www.ncbi.nlm.nih.gov/pubmed/17932905) PUI L350174942 DOI 10.1002/cncr.23067 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.23067 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 435 TITLE Attitudes toward genetic testing for cancer risk after genetic counseling and decision support: A qualitative comparison between hereditary cancer types AUTHOR NAMES Wakefield C.E. Kasparian N.A. Meiser B. Homewood J. Kirk J. Tucker K. AUTHOR ADDRESSES (Wakefield C.E., c.wakefield@unsw.edu.au; Homewood J.) Department of Psychology, Macquarie University, NSW, Australia. (Wakefield C.E., c.wakefield@unsw.edu.au; Kasparian N.A.; Meiser B.; Tucker K.) Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia. (Wakefield C.E., c.wakefield@unsw.edu.au; Kasparian N.A.; Meiser B.) School of Psychiatry, University of NSW, Randwick, NSW, Australia. (Kirk J.) Familial Cancer Service, Westmead Hospital, Westmead, NSW, Australia. (Tucker K.) Prince of Wales Clinical School, University of NSW, Randwick, NSW, Australia. (Wakefield C.E., c.wakefield@unsw.edu.au) Psychosocial Research Group (PRG), Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW 2031, Australia. CORRESPONDENCE ADDRESS C.E. Wakefield, Psychosocial Research Group (PRG), Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW 2031, Australia. Email: c.wakefield@unsw.edu.au SOURCE Genetic Testing (2007) 11:4 (401-411). Date of Publication: 1 Dec 2007 ISSN 1090-6576 BOOK PUBLISHER Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, United States. ABSTRACT This study aimed to qualitatively assess individuals' attitudes toward genetic testing for cancer risk after genetic counseling and decision support. As part of a larger study, 78 women considering genetic testing for hereditary breast/ovarian cancer (HBOC) risk and 22 individuals considering genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) completed an open-ended table of their perceived pros and cons of genetic testing. The most frequently reported pros were "to help manage my risk of developing cancer," "to help my family," and "to know my cancer risk." With regards to risk management, the HBOC group perceived genetic testing as most helpful in informing their general risk management practices, while the HN-PCC group focused on the potential to clarify their need for bowel cancer screening, suggesting that patients' perceptions of the benefits of genetic testing may differ across cancer syndromes. Individuals in both groups expressed concern about the potential psychological impact of genetic testing. We also found that some affected individuals may not fully comprehend the meaning of their potential test results. Eliciting patients' perceived pros and cons during genetic counseling is likely to be a valuable tool for improving patient care. This data also provides an improved evidence base for the development of patient education tools. © 2007 Mary Ann Liebert, Inc. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) genetic screening hereditary tumor (diagnosis, epidemiology, etiology) patient attitude EMTREE MEDICAL INDEX TERMS adult article Australia breast cancer (epidemiology) cancer classification cancer risk cancer screening colorectal cancer (epidemiology) controlled study decision support system evidence based practice female genetic counseling human human cell human tissue major clinical study ovary cancer (epidemiology) patient care patient education qualitative analysis risk management EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008029810 MEDLINE PMID 18294057 (http://www.ncbi.nlm.nih.gov/pubmed/18294057) PUI L351103393 DOI 10.1089/gte.2007.0013 FULL TEXT LINK http://dx.doi.org/10.1089/gte.2007.0013 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 436 TITLE Information acquisition for women facing surgical treatment for breast cancer: Influencing factors and selected outcomes AUTHOR NAMES O'Leary K.A. Estabrooks C.A. Olson K. Cumming C. AUTHOR ADDRESSES (O'Leary K.A., koleary@ualberta.ca; Estabrooks C.A.) Knowledge Utilization Studies Program, University of Alberta, Canada. (O'Leary K.A., koleary@ualberta.ca; Estabrooks C.A.; Olson K.) Faculty of Nursing, University of Alberta, Canada. (Olson K.; Cumming C.) Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Canada. CORRESPONDENCE ADDRESS K.A. O'Leary, Knowledge Utilization Studies Program, University of Alberta, Canada. Email: koleary@ualberta.ca SOURCE Patient Education and Counseling (2007) 69:1-3 (5-19). Date of Publication: December 2007 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: To examine, summarize, and critically assess the literature focusing on information use by early-stage breast cancer patients. Methods: Empirical articles reporting the information needs, sources used/preferred, and intervention-related outcomes experienced by patients in the context of making a treatment choice were chosen. Several healthcare databases were searched. Articles were limited to those published in English between January 1, 1986 and March 31, 2006. Results: A total of 25 articles met the inclusion criteria. Information needs were consistent, and highest rankings were for (in order): information about chances for a cure, stage of disease, and treatment options. Results were equivocal regarding the factors found to influence information need: age, time since diagnosis, and preferred role in decision-making. The highest ranked information sources accessed and preferred were physicians. Age, education, and type of treatment chosen influenced source choice. Patients using consumer decision aids (CDAs) had less decisional conflict, higher satisfaction with the decision made and the decision process, and higher knowledge levels. Conclusion: Information needs and source use were influenced by several personal and contextual factors. Practice implications: A better understanding of source use could provide more effective ways of disseminating information to patients. © 2007 Elsevier Ireland Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) patient education EMTREE MEDICAL INDEX TERMS cancer research cancer surgery decision making doctor patient relation health care health care delivery health promotion help seeking behavior human mastectomy partial mastectomy patient participation priority journal review surgical technique treatment outcome treatment planning EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007536729 MEDLINE PMID 17889495 (http://www.ncbi.nlm.nih.gov/pubmed/17889495) PUI L350051680 DOI 10.1016/j.pec.2007.08.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2007.08.002 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 437 TITLE A data mining approach to analyze non-compliance with a guideline for the treatment of breast cancer. AUTHOR NAMES Razavi A.R. Gill H. Ahlfeldt H. Shahsavar N. AUTHOR ADDRESSES (Razavi A.R.; Gill H.; Ahlfeldt H.; Shahsavar N.) Department of Biomedical Engineering, Division of Medical Informatics, Linköping University, Sweden. CORRESPONDENCE ADDRESS A.R. Razavi, Department of Biomedical Engineering, Division of Medical Informatics, Linköping University, Sweden. Email: amirreza.razavi@imt.liu.se SOURCE Medinfo. MEDINFO (2007) 12:Pt 1 (591-595). Date of Publication: 2007 ABSTRACT Postmastectomy radiotherapy (PMRT) is prescribed in order to reduce the local recurrence of breast cancer and improve overall survival. A guideline supports the trade-off between benefits and adverse effects of PMRT. However, this guideline is not always followed in practice. This study tries to find a method for revealing patterns of non-compliance between the actual treatment and the PMRT guideline. Data from breast cancer patients admitted to Linköping University Hospital between 1990 and 2000 were analyzed in this study. Cases that were not treated in accordance with the guideline were selected and analyzed by decision tree induction (DTI). Thereafter, four resulting rules, as representations for groups of patients, were compared to the guideline. Finding patterns of non-compliance with guidelines by means of rules can be an appropriate alternative to manual methods, i.e. a case-by-case comparison when studying very large datasets. The resulting rules can be used in a knowledge base of a guideline-based decision support system to alert when inconsistencies with the guidelines may appear. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (radiotherapy, surgery) decision tree practice guideline EMTREE MEDICAL INDEX TERMS adjuvant therapy article human information retrieval mastectomy statistical analysis utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 17911785 (http://www.ncbi.nlm.nih.gov/pubmed/17911785) PUI L350312240 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 438 TITLE Health professional and consumer views on involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan AUTHOR NAMES Butow P. Harrison J.D. Choy E.T. Young J.M. Spillane A. Evans A. AUTHOR ADDRESSES (Butow P.) School of Psychology, University of Sydney, Sydney, NSW, Australia. (Butow P.; Harrison J.D., james.harrison@email.cs.nsw.gov.au; Young J.M.) Surgical Outcome Research Centre (SOuRCe), Sydney South West Area Health Service, University of Sydney, Sydney, NSW, Australia. (Choy E.T.; Spillane A.) Sydney Breast Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia. (Evans A.) National Breast Cancer Centre, Sydney, NSW, Australia. (Harrison J.D., james.harrison@email.cs.nsw.gov.au) Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Missenden Road, NSW 2050, Australia. CORRESPONDENCE ADDRESS J.D. Harrison, Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Missenden Road, NSW 2050, Australia. Email: james.harrison@email.cs.nsw.gov.au SOURCE Cancer (2007) 110:9 (1937-1944). Date of Publication: 1 Nov 2007 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. The aim was to obtain the views of health professionals and patients about the concept of involving breast cancer patients in the multidisciplinary (MD) treatment planning meeting. METHODS. Breast cancer surgeons, nurses, oncologists, and patient advocates completed a mailed questionnaire. RESULTS. The majority of breast cancer health professionals and patient advocates support shared decision-making (58%-62%). However, less than a third of surgeons (32%), medical (25%), and radiation oncologists (24%) were supportive of involving women in the MD treatment planning meeting. In contrast, 93% of breast cancer advocates and 73% of breast cancer nurses were supportive of this approach. Patient advocates were significantly more in favor than all other groups (χ(2) = 148.8, df = 4, P < .001). The common reasons for supporting patient involvement included that it would lead to patients being more informed and empowered, provide them with an opportunity to ask questions, facilitate decision-making, and improve communication between the patient and the medical team. Health professionals stated that attendance would make patients anxious and that they would have to modify their medical language. Suggestions about how to manage patient involvement included the patient being supported by a breast nurse and pre-education before the meeting. Patient advocates were significantly more willing to participate in a randomized controlled trial of this process compared with all other groups, (χ(2) = 155.15, df= 4, P <.001). CONCLUSIONS. Despite health professional's reservations, patient advocates were highly supportive of including women in the MD meeting. Such a high demand justifies consideration of this option. © 2007 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (etiology) cancer patient EMTREE MEDICAL INDEX TERMS article cancer surgery consumer decision making doctor patient relation female health practitioner human language major clinical study male patient advocacy patient participation priority journal questionnaire shared decision making teamwork treatment planning EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007532545 MEDLINE PMID 17823912 (http://www.ncbi.nlm.nih.gov/pubmed/17823912) PUI L350036851 DOI 10.1002/cncr.23007 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.23007 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 439 TITLE Putting shared decision making to work in breast and prostate cancers: Tools for community oncologists AUTHOR NAMES Sepucha K.R. Belkora J. AUTHOR ADDRESSES (Sepucha K.R., ksepucha@partners.org) Health Decision Research Unit, Massachusetts General Hospital, Boston, MA, United States. (Belkora J.) Decision Services, University of California, San Francisco, CA, United States. (Sepucha K.R., ksepucha@partners.org) Health Decision Research Unit, MGH, 50 Stanford Street, Boston, MA 02114, United States. CORRESPONDENCE ADDRESS K.R. Sepucha, Health Decision Research Unit, MGH, 50 Stanford Street, Boston, MA 02114, United States. Email: ksepucha@partners.org SOURCE Community Oncology (2007) 4:11 (685-691). Date of Publication: November 2007 ISSN 1548-5315 BOOK PUBLISHER Elsevier Oncology, 46 Green Street, 2nd Floor, Huntington, United States. ABSTRACT A diagnosis of prostate or breast cancer throws patients into a state of cognitive and emotional overload. Patient anxiety and confusion can be exacerbated when there is no single dominant treatment, but rather multiple treatment options that require patients and oncologists to make trade-offs between benefits and harms. Patients rely on their oncologists to guide them to good decisions. There are an increasing number of tools available to help oncologists engage and educate their patients before, during, and after consultations. We discuss four tools that are available to community oncology practices: decision aids; prompt sheets; knowledge and preference surveys; and structured consultation notes. Community oncologists may wish to adapt and implement these tools in their practices to help their patients make informed choices. © 2007 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer prostate cancer EMTREE MEDICAL INDEX TERMS anxiety cancer chemotherapy cancer hormone therapy cancer patient cancer radiotherapy cancer screening cancer surgery cognition decision making human oncology review EMBASE CLASSIFICATIONS Endocrinology (3) Radiology (14) Cancer (16) Urology and Nephrology (28) Psychiatry (32) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007595018 PUI L350220716 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 440 TITLE Development and testing of a decision aid for breast cancer prevention for women with a BRCA1 or BRCA2 mutation AUTHOR NAMES Metcalfe K.A. Poll A. O'Connor A. Gershman S. Armel S. Finch A. Demsky R. Rosen B. Narod S.A. AUTHOR ADDRESSES (Metcalfe K.A., kelly.metcalfe@utoronto.ca; Gershman S.) Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada. (Metcalfe K.A., kelly.metcalfe@utoronto.ca; Poll A.; Gershman S.; Finch A.; Narod S.A.) Women's College Research Institute, Toronto, ON, Canada. (O'Connor A.) Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada. (Armel S.; Finch A.; Demsky R.; Rosen B.) Division of Gynecologic Oncology, University Health Network, Toronto, ON, Canada. CORRESPONDENCE ADDRESS K.A. Metcalfe, Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada. Email: kelly.metcalfe@utoronto.ca SOURCE Clinical Genetics (2007) 72:3 (208-217). Date of Publication: September 2007 ISSN 0009-9163 1399-0004 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT For women who carry a mutation in BRCA1 or BRCA2, the risk of breast cancer is up to 87% by the age of 70. There are options available to reduce the risk of breast cancer; however, each option has both risks and benefits, which makes decision making difficult. The objective is to develop and pilot test a decision aid for breast cancer prevention for women with a BRCA1 or BRCA2 mutation. The decision aid was developed and evaluated in three stages. In the first stage, the decision aid was developed and reviewed by cancer genetics experts. The second stage was a review of the decision aid by women with a BRCA1 or BRCA2 mutation for acceptability and feasibility. The final stage was a pre-test-post-test evaluation of the decision aid. Twenty-one women completed the pre-test questionnaire and 20 completed the post-test questionnaire. After using the decision aid, there was a significant decline in mean decisional conflict scores (p = 0.001), a significant improvement in knowledge scores (p = 0.004), and fewer women uncertain about prophylactic mastectomy (p = 0.003) and prophylactic oophorectomy (p = 0.009). Use of the decision aid decreased decisional conflict to levels suggestive of implementation of a decision. In addition, knowledge levels increased and choice predisposition changed with fewer women being uncertain about each option. This has significant clinical implications as it implies that with greater uptake of cancer prevention options by women with a BRCA1 or BRCA2 mutation, fewer women will develop and/or die of hereditary breast cancer. © 2007 The Authors Journal compilation. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (etiology, prevention, surgery) EMTREE MEDICAL INDEX TERMS adult aged article cancer genetics cancer mortality cancer risk clinical article conflict controlled study feasibility study female gene mutation heredity human knowledge mastectomy medical decision making medical expert ovariectomy patient attitude patient decision making pilot study pretest posttest design priority journal prophylaxis questionnaire risk benefit analysis risk reduction scoring system uncertainty EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007413698 MEDLINE PMID 17718858 (http://www.ncbi.nlm.nih.gov/pubmed/17718858) PUI L47300023 DOI 10.1111/j.1399-0004.2007.00859.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1399-0004.2007.00859.x COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 441 TITLE Specimen shrinkage and its influence on margin assessment in breast cancer AUTHOR NAMES Yeap B.H. Muniandy S. Lee S.-K. Sabaratnam S. Singh M. AUTHOR ADDRESSES (Yeap B.H., drbhyeap@hotmail.com; Muniandy S.; Lee S.-K.; Sabaratnam S.; Singh M.) Department of General Surgery, Penang General Hospital, Penang, Malaysia. (Yeap B.H., drbhyeap@hotmail.com) Department of General Surgery, Penang General Hospital, Jalan Residensi, 10990 Pulau Pinang, Malaysia. CORRESPONDENCE ADDRESS B.H. Yeap, Department of General Surgery, Penang General Hospital, Jalan Residensi, 10990 Pulau Pinang, Malaysia. Email: drbhyeap@hotmail.com SOURCE Asian Journal of Surgery (2007) 30:3 (183-187). Date of Publication: July 2007 ISSN 1015-9584 0219-3108 (electronic) BOOK PUBLISHER Elsevier (Singapore) Pte Ltd ABSTRACT OBJECTIVE: The determination of tumour-free margin in breast cancer is crucial in deciding subsequent patient management. To exemplify the phenomenon of margin contraction during specimen preparation for histopathological analysis, we quantified the shrinkage of breast specimens as a result of formalin fixation. METHODS: Fifty consecutive mastectomy and wide excision specimens were prospectively appraised. The closest free margin and maximal tumour diameter of fresh, unprepared specimens were recorded. These measurements were compared with the corresponding parameters following tissue fixation. RESULTS: Following formalin fixation, the mean closest free margin of the specimens was found to have decreased from 10.28 mm to 6.78 mm (34%). The reduction of the mean diameter of the tumour itself was less significant, from 41.74 mm to 39.88 mm (4.5%). CONCLUSION: Breast specimens undergo shrinkage after histological fixation, losing more than a third of their original closest free margin, whilst the tumour itself does not shrink substantially. This phenomenon has vital implications in the accuracy of margin analysis and consequent decisions on further management, including re-operation and the institution of adjuvant radiotherapy. © 2007 Elsevier. All rights reserved. EMTREE DRUG INDEX TERMS fixative (pharmacology) formaldehyde (pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) tissue fixation EMTREE MEDICAL INDEX TERMS adult aged article female human mastectomy methodology middle aged minimal residual disease pathology tissue culture technique CAS REGISTRY NUMBERS formaldehyde (50-00-0) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 17638637 (http://www.ncbi.nlm.nih.gov/pubmed/17638637) PUI L47253865 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 442 TITLE The context influences doctors' support of shared decision-making in cancer care AUTHOR NAMES Shepherd H.L. Tattersall M.H.N. Butow P.N. AUTHOR ADDRESSES (Shepherd H.L., heathers@med.usyd.edu.au; Tattersall M.H.N.) Medical Psychology Research Unit, Faculty of Medicine, University of Sydney, NSW 2006, Australia. (Butow P.N.) Medical Psychology Research Unit, School of Psychology, University of Sydney, NSW 2006, Australia. CORRESPONDENCE ADDRESS H.L. Shepherd, Medical Psychology Research Unit, Faculty of Medicine, University of Sydney, NSW 2006, Australia. Email: heathers@med.usyd.edu.au SOURCE British Journal of Cancer (2007) 97:1 (6-13). Date of Publication: 26 Jun 2007 ISSN 0007-0920 1532-1827 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequent usual practice. Multivariate analysis showed that specialisation in breast or urological cancers compared to other cancers (AOR 3.02), high caseload of new patients per month (AOR 2.81) and female gender (AOR 1.87) were each independently associated with increased likelihood of use of SDM. Barriers exist to the application of SDM by doctors according to clinical situation and clinician characteristics. © 2007 Cancer Research UK. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) malignant neoplasm (epidemiology) EMTREE MEDICAL INDEX TERMS adult aged article attitude breast cancer clinical practice colorectal cancer comparative study decision making female female genital tract cancer gender health survey human major clinical study male medical information multivariate analysis prediction priority journal univariate analysis urinary tract cancer EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007318098 MEDLINE PMID 17551491 (http://www.ncbi.nlm.nih.gov/pubmed/17551491) PUI L47012096 DOI 10.1038/sj.bjc.6603841 FULL TEXT LINK http://dx.doi.org/10.1038/sj.bjc.6603841 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 443 TITLE Is there a role for decision aids in cancer-related decisions? AUTHOR NAMES Neuman H.B. Charlson M.E. Temple L.K. AUTHOR ADDRESSES (Neuman H.B.) Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. (Neuman H.B.) Weill Medical College, Cornell University, New York, NY, United States. (Charlson M.E.) Division of General Internal Medicine, New York, NY, United States. (Charlson M.E.) Center for Complementary and Integrative Medicine, Weill Medical College, Cornell University, New York, NY, United States. (Temple L.K., templel@mskcc.org) Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. CORRESPONDENCE ADDRESS L.K. Temple, Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. Email: templel@mskcc.org SOURCE Critical Reviews in Oncology/Hematology (2007) 62:3 (240-250). Date of Publication: June 2007 ISSN 1040-8428 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Cancer-related decisions are challenging, requiring patients to evaluate associated medical and psychological outcomes within the context of their personal values. In response, a number of decisional support tools have been developed. Clinical decision aids are decisional support tools designed to facilitate patient-driven decision-making by providing relevant information on the options while eliciting and incorporating patient preferences; they have been designed to support decision-making in the prevention, screening, and treatment of cancer. The development begins with identification of an appropriate clinical problem, followed by needs assessment to determine content and optimal methods of data presentation. Because implementation of a decision aid requires time and financial commitment, its efficacy in improving the quality of patients' decisions must be evaluated. In randomized controlled trials, cancer-related decision aids have been shown to increase patients' knowledge regarding their disease, and may facilitate patients playing a more active role in decision-making. Some studies suggest less decisional conflict and improved satisfaction with decision-making as a result. Whether use of a decision aid impacts the actual decisions made by patients, however, is less evident. © 2007 Elsevier Ireland Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical decision making malignant neoplasm (prevention) EMTREE MEDICAL INDEX TERMS breast cancer (prevention) cancer patient cancer prevention cancer screening cancer therapy chronic myeloid leukemia clinical effectiveness colon cancer consultation decision support system human non small cell lung cancer ovary cancer patient decision making patient satisfaction prostate cancer psychological aspect review total quality management EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007216109 MEDLINE PMID 17317206 (http://www.ncbi.nlm.nih.gov/pubmed/17317206) PUI L46679284 DOI 10.1016/j.critrevonc.2006.12.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.critrevonc.2006.12.006 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 444 TITLE Improving informed consent in clinical trials: Successful piloting of a decision aid [1] AUTHOR NAMES Juraskova I. Butow P. Lopez A.-L. Seccombe M. Boyle F. McCarthy N. Forbes J.F. AUTHOR ADDRESSES (Juraskova I.; Butow P.; Lopez A.-L.) Medical Psychology Research Unit, School of Psychology, University of Sydney, NSW, Australia. (Seccombe M.; Forbes J.F.) Australian New Zealand Breast Cancer Trials Group, University of Newcastle, NSW, Australia. (Boyle F.) Pam McLean Cancer Communications Centre, University of Sydney, NSW, Australia. (McCarthy N.) Department of Medical Oncology, Royal Brisbane Hospital, QLD, Australia. CORRESPONDENCE ADDRESS I. Juraskova, Medical Psychology Research Unit, School of Psychology, University of Sydney, NSW, Australia. SOURCE Journal of Clinical Oncology (2007) 25:11 (1443-1444). Date of Publication: 10 Apr 2007 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. EMTREE DRUG INDEX TERMS anastrozole (adverse drug reaction, clinical trial, drug therapy) tamoxifen (clinical trial, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) carcinoma in situ (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS cancer risk clinical trial controlled clinical trial decision making human informed consent letter mastectomy medical ethics medical information meta analysis patient compliance postmenopause priority journal randomized controlled trial systematic review unspecified side effect (side effect) CAS REGISTRY NUMBERS anastrozole (120511-73-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007225458 MEDLINE PMID 17416867 (http://www.ncbi.nlm.nih.gov/pubmed/17416867) PUI L46706896 DOI 10.1200/JCO.2006.09.5471 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2006.09.5471 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 445 TITLE Association of information satisfaction, psychological distress and monitoring coping style with post-decision regret following breast reconstruction AUTHOR NAMES Sheehan J. Sherman K.A. Lam T. Boyages J. AUTHOR ADDRESSES (Sheehan J.; Sherman K.A., Kerry.Sherman@psy.mq.edu.au) Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. (Sherman K.A., Kerry.Sherman@psy.mq.edu.au; Lam T.; Boyages J.) NSW Breast Cancer Institute, Westmead Hospital, Westmead, NSW, Australia. CORRESPONDENCE ADDRESS K.A. Sherman, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. Email: Kerry.Sherman@psy.mq.edu.au SOURCE Psycho-Oncology (2007) 16:4 (342-351). Date of Publication: April 2007 ISSN 1057-9249 1099-1611 (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Little is known of the psychosocial factors associated with decision regret in the context of breast reconstruction following mastectomy for breast cancer treatment. Moreover, there is a paucity of theoretically-based research in the area of post-decision regret. Adopting the theoretical framework of the Monitoring Process Model (Cancer 1995;76(1):167-177), the current study assessed the role of information satisfaction, current psychological distress and the moderating effect of monitoring coping style to the experience of regret over the decision to undergo reconstructive surgery. Women (N = 123) diagnosed with breast cancer who had undergone immediate or delayed breast reconstruction following mastectomy participated in the study. The majority of participants (52.8%, n = 65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with low satisfaction with preparatory information, depression, anxiety and stress. Multinominal logistic regression analysis showed, controlling for mood state and time since last reconstructive procedure, that lower satisfaction with information and increased depression were associated with increased likelihood of experiencing regret. Monitoring coping style moderated the association between anxiety and regret (β = -0.10, OR = 0.91, p = 0.01), whereby low monitors who were highly anxious had a greater likelihood of experiencing regret than highly anxious high monitors. Copyright © 2006 John Wiley & Sons, Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction coping behavior distress syndrome medical decision making patient education EMTREE MEDICAL INDEX TERMS adult aged anxiety article bivariate analysis breast cancer (diagnosis, surgery) controlled study correlation analysis depression female human logistic regression analysis major clinical study mastectomy medical information mood outcomes research patient monitoring patient satisfaction postoperative period prediction social psychology social support EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007216612 MEDLINE PMID 16874745 (http://www.ncbi.nlm.nih.gov/pubmed/16874745) PUI L46681104 DOI 10.1002/pon.1067 FULL TEXT LINK http://dx.doi.org/10.1002/pon.1067 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 446 TITLE p27(KIP-1) cyclin A and cyclin D1 protein expression in ductal carcinoma in situ of the breast: p27(KIP-1) correlates with hormone receptor status but not with local recurrence AUTHOR NAMES Millar E.K.A. Tran K. Marr P. Graham P.H. AUTHOR ADDRESSES (Millar E.K.A., ewan.millar@sesiahs.health.nsw.gov.au; Tran K.; Marr P.) Department of Anatomical Pathology, South-Eastern Area Laboratory Service, St. George Hospital, Kogarah, NSW, Australia. (Graham P.H.) Department of Radiation Oncology, Cancer Care Center, St. George Hospital, Kogarah, NSW, Australia. (Millar E.K.A., ewan.millar@sesiahs.health.nsw.gov.au; Graham P.H.) University of New South Wales, NSW, Australia. (Millar E.K.A., ewan.millar@sesiahs.health.nsw.gov.au) Department of Anatomical Pathology, South-eastern Area Laboratory Service, St. George Hospital, Gray Street, Kogarah, NSW 2217, Australia. CORRESPONDENCE ADDRESS E.K.A. Millar, Department of Anatomical Pathology, South-eastern Area Laboratory Service, St. George Hospital, Gray Street, Kogarah, NSW 2217, Australia. Email: ewan.millar@sesiahs.health.nsw.gov.au SOURCE Pathology International (2007) 57:4 (183-189). Date of Publication: April 2007 ISSN 1320-5463 1440-1827 (electronic) BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Using whole sections of formalin-fixed paraffin-embedded material the expression of p27(KIP-1), cyclin A and cyclin D1 was examined in 60 cases of ductal carcinoma in situ (DCIS) using routine immunohistochemistry with a median follow up of 95 months (range 10-139 months) to identify any association with disease recurrence. Fifty-six patients were treated by local excision and radiotherapy and four by mastectomy without radiotherapy. There was a highly significant positive association between p27(KIP-1) and estrogen receptor/progesterone receptor (ER/PR) status (P = 0.002, P = 0.02) and with p27(KIP-1) and cyclin D1 expression (P = 0.002). A trend between cyclin A and PR status (P = 0.08) was also identified. These findings mirror those described in invasive ductal carcinoma, but there were no associations of any biomarker with histological parameters such as nuclear grade or with local recurrence on univariate analysis, which was present in four of the 56 locally excised group (7.1%). Further examination of a larger cohort may be worthwhile to explore the possible role as adjunctive predictive markers to aid clinical decision making. © 2007 The Authors. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cyclin A (endogenous compound) cyclin D1 (endogenous compound) cyclin dependent kinase inhibitor 1B (endogenous compound) hormone receptor (endogenous compound) EMTREE DRUG INDEX TERMS biological marker (endogenous compound) estrogen receptor (endogenous compound) formaldehyde paraffin progesterone receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (diagnosis) carcinoma in situ (diagnosis) intraductal carcinoma (diagnosis) EMTREE MEDICAL INDEX TERMS adult aged article cancer grading cancer radiotherapy cancer recurrence (complication) cancer surgery cell cycle cohort analysis correlation analysis disease association follow up histology human human tissue immunohistochemistry major clinical study mastectomy medical decision making priority journal prognosis protein expression recurrent disease (complication) univariate analysis CAS REGISTRY NUMBERS formaldehyde (50-00-0) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007096731 MEDLINE PMID 17316413 (http://www.ncbi.nlm.nih.gov/pubmed/17316413) PUI L46279946 DOI 10.1111/j.1440-1827.2007.02079.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1440-1827.2007.02079.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 447 TITLE Decision aids and breast cancer: Do they influence choice for surgery and knowledge of treatment options? AUTHOR NAMES Waljee J.F. Rogers M.A.M. Alderman A.K. AUTHOR ADDRESSES (Waljee J.F., filip@med.umich.edu) 6312 Medical Sciences Building I, 1150 West Medical Center Dr, Ann Arbor, MI 48109, United States. (Rogers M.A.M.; Alderman A.K.) CORRESPONDENCE ADDRESS J.F. Waljee, 6312 Medical Sciences Building I, 1150 West Medical Center Dr, Ann Arbor, MI 48109, United States. Email: filip@med.umich.edu SOURCE Journal of Clinical Oncology (2007) 25:9 (1067-1073). Date of Publication: 20 Mar 2007 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT 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. © 2007 by American Society of Clinical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) medical decision making treatment planning EMTREE MEDICAL INDEX TERMS article clinical trial computer aided design controlled clinical trial counseling doctor patient relation human mastectomy medical practice meta analysis organ preservation patient education patient participation priority journal randomized controlled trial systematic review EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007186717 MEDLINE PMID 17369570 (http://www.ncbi.nlm.nih.gov/pubmed/17369570) PUI L46596758 DOI 10.1200/JCO.2006.08.5472 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2006.08.5472 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 448 TITLE Time to decide about risk-reducing mastectomy: A case series of BRCA1/2 gene mutation carriers AUTHOR NAMES McCullum M. Bottorff J.L. Kelly M. Kieffer S.A. Balneaves L.G. AUTHOR ADDRESSES (McCullum M., mmccullum@bccancer.bc.ca) Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC, Canada. (Bottorff J.L., joan.bottorff@ubc.ca; Kelly M., marykelly@nursing.ubc.ca; Kieffer S.A., skieffer@cw.bc.ca; Balneaves L.G., balneaves@nursing.ubc.ca) School of Nursing, University of British Columbia, Vancouver, BC, Canada. (Bottorff J.L., joan.bottorff@ubc.ca) Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, BC, Canada. (Kieffer S.A., skieffer@cw.bc.ca) Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada. CORRESPONDENCE ADDRESS M. McCullum, Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC, Canada. Email: mmccullum@bccancer.bc.ca SOURCE BMC Women's Health (2007) 7 Article Number: 3. Date of Publication: 6 Mar 2007 ISSN 1472-6874 (electronic) BOOK PUBLISHER BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom. ABSTRACT Background: The purpose of this research was to explore women's decision-making experiences related to the option of risk-reducing mastectomy (RM), using a case series of three women who are carriers of a BRCA1/2 gene mutation. Methods: Data was collected in a pilot study that assessed the response of women to an information booklet about RM and decision-making support strategies. A detailed analysis of three women's descriptions of their decision-making processes and outcomes was conducted. Results: All three women were carriers of a BRCA1/2 gene mutation and, although undecided, were leaning towards RM when initially assessed. Each woman reported a different RM decision outcome at last follow-up. Case #1 decided not to have RM, stating that RM was "too radical" and early detection methods were an effective strategy for dealing with breast cancer risk. Case #2 remained undecided about RM and, over time, she became less prepared to make a decision because she felt she did not have sufficient information about surgical effects. Case #3 had undergone RM by the time of her second follow-up interview and reported that she felt "a load off (her) mind now". Conclusion: RM decision making may shift over time and require decision support over an extended period. © 2007 McCullum et al; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy EMTREE MEDICAL INDEX TERMS adult article attitude to illness cancer risk case report consultation early diagnosis family history female gene mutation genetic counseling genetic screening heterozygote human hysterectomy medical literature ovariectomy patient decision making patient education quality of life risk reduction strategic planning uncertainty EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009043395 PUI L354104921 DOI 10.1186/1472-6874-7-3 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6874-7-3 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 449 TITLE Pilot trial of a computerized decision aid for breast cancer prevention AUTHOR NAMES Ozanne E.M. Annis C. Adduci K. Showstack J. Esserman L. AUTHOR ADDRESSES (Ozanne E.M., elissa@mgh-ita.org) Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. (Annis C.; Adduci K.; Esserman L.) Carol Franc Buck Breast Care Center, University of California, San Francisco Medical Center, San Francisco, CA, United States. (Showstack J.) Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA, United States. (Esserman L.) Department of Surgery and Radiology, University of California, San Francisco Medical Center, San Francisco, CA, United States. (Ozanne E.M., elissa@mgh-ita.org) Institute for Technology Assessment at MGH, 101 Merrimac St., Boston, MA 02114, United States. CORRESPONDENCE ADDRESS E.M. Ozanne, Institute for Technology Assessment at MGH, 101 Merrimac St., Boston, MA 02114, United States. Email: elissa@mgh-ita.org SOURCE Breast Journal (2007) 13:2 (147-154). Date of Publication: March/April 2007 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment. Thirty participants enrolled (15 per group) and completed measures of clinical feasibility and effectiveness prior to, immediately after, and at 9 months after their consultations. The decision aid was feasible to use during the consultations as measured by consultation duration, user satisfaction, patient knowledge, and decisional conflict. The mean consultation duration was not significantly different between groups (24 minutes for intervention group versus 21 minutes for control group, p = 0.42). The majority found the decision aid acceptable and useful and would recommend it to others. Both groups showed an improvement in breast cancer prevention knowledge postvisit, which was significant in the intervention group (p = 0.01) but not the control group (p = 0.13). However, the knowledge scores returned to baseline at follow-up in both groups. Decision preference for patients who chose chemoprevention post consultations remained constant at follow-up for the intervention group, but not for the control group. The decision framework provides access to key information during consultations and facilitates the integration of emerging biomarkers in this setting. Initial results suggest that the decision aid is feasible for use in the consultation room. The tendency for the decision choices and knowledge scores to return to baseline at follow-up suggests the need for initial and ongoing prevention decision support. © 2007 Blackwell Publishing, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (prevention) cancer prevention decision support system EMTREE MEDICAL INDEX TERMS access to information adult aged article cancer risk clinical article computer aided design consultation controlled study follow up health program human intermethod comparison intervention study medical decision making patient satisfaction pilot study randomization statistical significance EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007097209 MEDLINE PMID 17319855 (http://www.ncbi.nlm.nih.gov/pubmed/17319855) PUI L46280605 DOI 10.1111/j.1524-4741.2007.00395.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1524-4741.2007.00395.x COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 450 TITLE Acupuncture for chemotherapy-associated cognitive dysfunction: A hypothesis-generating literature review to inform clinical advice AUTHOR NAMES Johnston M.F. Yang C. Hui K.-K. Xiao B. Li X. Rusiewicz A. AUTHOR ADDRESSES (Johnston M.F., johnston@ucla.edu; Hui K.-K.) Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States. (Yang C.; Xiao B.) Emperor's College of Traditional Oriental Medicine, Santa Monica, CA, United States. (Li X.) Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States. (Rusiewicz A.) Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, United States. (Johnston M.F., johnston@ucla.edu) Center for East-West Medicine, David Geffen School of Medicine at UCLA, 2428 Santa Monica Boulevard, Santa Monica, CA 90404, United States. CORRESPONDENCE ADDRESS M.F. Johnston, Center for East-West Medicine, David Geffen School of Medicine at UCLA, 2428 Santa Monica Boulevard, Santa Monica, CA 90404, United States. Email: johnston@ucla.edu SOURCE Integrative Cancer Therapies (2007) 6:1 (36-41). Date of Publication: March 2007 ISSN 1534-7354 1552-695X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT There is an emerging consensus that between one fifth and one half of breast cancer patients experience chemotherapy-associated cognitive dysfunction. Research shows that patients with cancer are often interested in acupuncture for symptom relief. A clinical question thus arises: What should physicians advise their patients regarding the use of acupuncture to alleviate or ameliorate chemotherapy-associated cognitive dysfunction? The authors review and synthesize 2 bodies of relevant research literature: (1) the developing literature on the etiology and nature of chemotherapy-associated cognitive dysfunction and (2) the literature concerning acupuncture for neurological diseases and psychological issues. There is evidence that acupuncture may be effectively used to manage a range of psychoneurological issues, some of which are similar to those experienced by patients with chemotherapy-associated cognitive dysfunction. The evidence of efficacy is more promising for psychological than neurological conditions. Given evidence of possible efficacy combined with evidence of demonstrated safety, we suggest that physicians should support patient decisions to use acupuncture services for chemotherapy- associated cognitive dysfunction, especially given the lack of proven alternatives. EMTREE DRUG INDEX TERMS antiinfective agent (adverse drug reaction) bortezomib (adverse drug reaction) cisplatin (adverse drug reaction) docetaxel (adverse drug reaction) fluorouracil (adverse drug reaction) methotrexate (adverse drug reaction) oxaliplatin (adverse drug reaction) paclitaxel (adverse drug reaction) taxane derivative (adverse drug reaction) Vinca alkaloid (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acupuncture chemotherapy cognitive defect (side effect, complication, etiology, side effect, therapy) EMTREE MEDICAL INDEX TERMS agitation anger anorexia (side effect) anxiety disorder (side effect) brain region cancer patient depression (side effect) fatigue (side effect) guilt hostility human learning disorder (side effect) memory disorder (side effect) nausea and vomiting (side effect) neurologic disease neurotoxicity (side effect) pain (side effect) paralysis (side effect) paresthesia (side effect) priority journal psychological aspect review seizure (side effect) sensory dysfunction (side effect) side effect (side effect) skin tingling (side effect) sleep disorder (side effect) thought disorder (side effect) treatment refusal withdrawal syndrome (side effect) CAS REGISTRY NUMBERS bortezomib (179324-69-7, 197730-97-5) cisplatin (15663-27-1, 26035-31-4, 96081-74-2) docetaxel (114977-28-5) fluorouracil (51-21-8) methotrexate (15475-56-6, 59-05-2, 7413-34-5) oxaliplatin (61825-94-3) paclitaxel (33069-62-4) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Cancer (16) Psychiatry (32) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007089356 MEDLINE PMID 17351025 (http://www.ncbi.nlm.nih.gov/pubmed/17351025) PUI L46257026 DOI 10.1177/1534735406298903 FULL TEXT LINK http://dx.doi.org/10.1177/1534735406298903 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 451 TITLE Individualized survival and treatment response predictions for breast cancers using phospho-EGFR, phospho-ER, phospho-HER2/neu, phospho-IGF-IR/In, phospho-MAPK, and phospho-p70S6K proteins AUTHOR NAMES Guo L. Abraham J. Flynn D.C. Castranova V. Shi X. Qian Y. AUTHOR ADDRESSES (Guo L., lguo@hsc.wvu.edu) MBR Cancer Center, Department of Community Medicine, West Virginia University, Morgantown, WV 26505, United States. (Abraham J.) Department of Medicine, Division of Hematology/Oncology, West Virginia University, Morgantown, WV 26505, United States. (Flynn D.C.) MBR Cancer Center, Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV 26505, United States. (Castranova V.; Shi X.; Qian Y., yaq2@cdc.gov) The Pathology and Physiology Research Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, United States. CORRESPONDENCE ADDRESS L. Guo, MBR Cancer Center, Department of Community Medicine, West Virginia University, Morgantown, WV 26505, United States. Email: lguo@hsc.wvu.edu SOURCE International Journal of Biological Markers (2007) 22:1 (1-11). Date of Publication: January/March 2007 ISSN 0393-6155 BOOK PUBLISHER Wichtig Editore s.r.l., Via Friuli 72/74, Milan, Italy. ABSTRACT The development and progression of breast cancer involves the activation of numerous protein kinases, and the change in phosphorylation is a hallmark of protein kinase activation. In this study, we identified a comprehensive profile to predict individual breast cancer patients' survival and treatment responses using the Random Committee algorithm. The profile incorporated a subset of phosphorylated signal protein expressions and several selected clinical factors of breast cancer. The parameters of our profile were identified by supervised feature selection algorithms, Gain Ratio Attribute Evaluation and Relief. The results showed that the overall accuracy of survival prediction reached 92.3% for individual breast cancer patients with the use of the expression profiles of phospho-EGFR, phospho-ER, phospho-HER2/ neu,phospho-IGF-IR/In, phospho-MAPK, and phospho-p70(S6K) plus the selected clinical factors. The results also indicated that the overall accuracy of treatment response prediction was 92.6% with the use of the level of phospho-EGFR, phospho-ER, phospho-HER2/neu, phospho-MAPK, and phospho-p70(S6K) plus the selected clinical information. The prediction system combines multiple signal protein activation profiles and relevant clinical information, and provides a unique guideline to aid individualized decision-making in the clinical management of breast cancer. © 2007 Wichtig Editore. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) phosphoprotein (endogenous compound) EMTREE DRUG INDEX TERMS epidermal growth factor receptor (endogenous compound) epidermal growth factor receptor 2 (endogenous compound) mitogen activated protein kinase (endogenous compound) protein kinase (endogenous compound) protein p70 (endogenous compound) somatomedin C receptor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS accuracy adult aged algorithm article cancer radiotherapy cancer survival clinical decision making disease free survival enzyme activation gene expression profiling human human tissue immunohistochemistry major clinical study partial mastectomy prediction prognosis protein expression protein phosphorylation signal transduction treatment response CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) mitogen activated protein kinase (142243-02-5) protein kinase (9026-43-1) EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007232849 MEDLINE PMID 17393355 (http://www.ncbi.nlm.nih.gov/pubmed/17393355) PUI L46730028 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 452 TITLE An informed decision?. Breast cancer patients and their knowledge about treatment AUTHOR NAMES Fagerlin A. Lakhani I. Lantz P.M. Janz N.K. Morrow M. Schwartz K. Deapen D. Salem B. Liu L. Katz S.J. AUTHOR ADDRESSES (Fagerlin A., fagerlin@umich.edu; Katz S.J.) VA Health Services Research, Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States. (Fagerlin A., fagerlin@umich.edu; Lakhani I.; Salem B.; Katz S.J.) Department of Internal Medicine, University of Michigan, United States. (Fagerlin A., fagerlin@umich.edu) Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, MI, United States. (Lantz P.M.; Katz S.J.) Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, United States. (Janz N.K.) Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States. (Morrow M.) Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States. (Schwartz K.) Department of Family Medicine, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States. (Deapen D.; Liu L.) Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS A. Fagerlin, VA Health Services Research, Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States. Email: fagerlin@umich.edu SOURCE Patient Education and Counseling (2006) 64:1-3 (303-312). Date of Publication: December 2006 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. Methods: We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N = 2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. Results: Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p < 0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p < 0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. Conclusion: Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. Practice implications: These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, epidemiology, surgery) cancer patient patient education EMTREE MEDICAL INDEX TERMS adult aged article breast surgery cancer diagnosis cancer recurrence cancer risk cancer surgery cancer survival cancer therapy carcinoma in situ (diagnosis, epidemiology, surgery) controlled study female health behavior health survey human Internet major clinical study mastectomy medical decision making medical information outcome assessment population research priority journal recurrence risk survival rate United States EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006568089 MEDLINE PMID 16860523 (http://www.ncbi.nlm.nih.gov/pubmed/16860523) PUI L44772969 DOI 10.1016/j.pec.2006.03.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.pec.2006.03.010 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 453 TITLE PET Scanning in Breast Cancer: A Clinician's Perspective AUTHOR NAMES Boasberg P. AUTHOR ADDRESSES (Boasberg P., pboasberg@theangelesclinic.org) Department of Medical Oncology, The Angeles Clinic, Research Institute, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS P. Boasberg, Department of Medical Oncology, The Angeles Clinic, Research Institute, Los Angeles, CA, United States. Email: pboasberg@theangelesclinic.org SOURCE Seminars in Breast Disease (2006) 9:4 (127-130). Date of Publication: December 2006 PET Scanning in Evaluation of Breast Cancer, Book Series Title: ISSN 1092-4450 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Breast cancer is the most common cancer among women excluding nonmelanotic skin cancers, and is the second leading cause of cancer deaths in women. In 2005, it is estimated there will be over 200,000 women diagnosed with breast cancer and approximately 40,000 deaths from the disease. Although the incidence of breast cancer remains high, the rate of death from breast cancer has recently been estimated to have diminished by 25% to 38% through the contribution of screening mammography and adjuvant therapy. Despite these advances, breast cancer continues to remain a major personal and public health issue. Oncologists are continually seeking tools to aid the treatment decisions for patients with breast cancer. At every stage of a patient's disease, accurate information is required to assess the extent of disease, the pattern of spread, and the response to therapy. The purpose of this paper is to review the existing data regarding the potential role of fluorodeoxyglucose positron emission topography (FDG-PET) scanning in the mangement of breast cancer patients from a clinician's viewpoint. © 2006 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) fluorodeoxyglucose EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, drug therapy, epidemiology, surgery) positron emission tomography EMTREE MEDICAL INDEX TERMS accuracy article axillary lymph node cancer adjuvant therapy cancer diagnosis cancer grading cancer incidence cancer mortality cancer screening cancer staging cancer survival cause of death clinical trial correlation analysis echomammography false negative result false positive result histopathology human lymph node dissection lymph node metastasis medical decision making medical information medical specialist meta analysis nuclear magnetic resonance imaging priority journal prognosis public health service sensitivity and specificity systematic review treatment planning treatment response tumor invasion CAS REGISTRY NUMBERS fluorodeoxyglucose (29702-43-0) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Nuclear Medicine (23) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007192462 PUI L46617326 DOI 10.1053/j.sembd.2007.02.002 FULL TEXT LINK http://dx.doi.org/10.1053/j.sembd.2007.02.002 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 454 TITLE Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective? AUTHOR NAMES Jeruss J.S. Hunt K.K. Xing Y. Krishnamurthy S. Meric-Bernstam F. Cantor S.B. Ross M.I. Cormier J.N. AUTHOR ADDRESSES (Jeruss J.S.; Hunt K.K.; Xing Y.; Meric-Bernstam F.; Ross M.I.; Cormier J.N., jcormier@mdanderson.org) Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Krishnamurthy S.) Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Cantor S.B.) Department of Biostatistics and Applied Mathematics, University of Texas M. D. Anderson Cancer Center, Houston, TX, United States. (Cormier J.N., jcormier@mdanderson.org) Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States. CORRESPONDENCE ADDRESS J.N. Cormier, Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States. Email: jcormier@mdanderson.org SOURCE Cancer (2006) 107:10 (2328-2336). Date of Publication: 15 Nov 2006 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. Sentinel lymph nodes (SLNs) are generally evaluated postoperatively, requiring 5-7 days for assessment. SLNs can also be evaluated intraoperatively by using touch imprint cytology (TIC), thus providing the surgeon immediate feedback and allowing for concurrent completion node dissection (CND) for positive SLNs. The authors hypothesized that TIC, when compared with standard postoperative SLN assessment alone, would permit a cost-effective evaluation of SLNs in patients with clinically node-negative breast cancer. METHODS. A decision-analysis model was created to compare TIC with standard postoperative SLN assessment alone. Sensitivity and specificity of TIC were determined prospectively from 342 patients who underwent SLN biopsy assessed by both techniques. Short-term health states associated with surgical staging were defined, and utilities were estimated using EuroQol-5D. Base-case analysis was performed to estimate quality-adjusted life years and the incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine stability of model parameters. RESULTS. For each tumor stage, TIC was cost effective, and for patients with larger tumors (T3 and T4), TIC was the dominant strategy. The analysis was robust to changes in sensitivity and specificity of TIC, prevalence of metastasis, probability of complications, and cost. However, when utility associated with standard SLN assessment was 0.9 or greater, this became the preferred strategy. CONCLUSIONS. TIC is cost effective for assessing SLN metastasis intraoperatively. For patients with larger tumors, it is not only more effective, but also less costly than standard SLN assessment alone. TIC may be particularly useful for patients who experience significant anxiety while awaiting results of standard SLN assessment. © 2006 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) cancer cytodiagnosis sentinel lymph node biopsy touch imprint cytology EMTREE MEDICAL INDEX TERMS article biomedical technology assessment controlled study cost benefit analysis cost utility analysis decision support system female health care cost human intermethod comparison intraoperative period major clinical study mastectomy priority journal quality adjusted life year sensitivity and specificity EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006560529 MEDLINE PMID 17039501 (http://www.ncbi.nlm.nih.gov/pubmed/17039501) PUI L44748515 DOI 10.1002/cncr.22275 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.22275 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 455 TITLE Changes in surgical management resulting from case review at a breast cancer multldisciplinary tumor board AUTHOR NAMES Newman E.A. Guest A.B. Helvie M.A. Roubidoux M.A. Chang A.E. Kleer C.G. Diehl K.M. Cimmino V.M. Pierce L. Hayes D. Newman L.A. Sabel M.S. AUTHOR ADDRESSES (Newman E.A.; Chang A.E.; Diehl K.M.; Cimmino V.M.; Newman L.A.; Sabel M.S., msabel@umich.edu) Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. (Guest A.B.; Helvie M.A.; Roubidoux M.A.) Department of Radiology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. (Kleer C.G.) Department of Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. (Pierce L.) Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. (Hayes D.) Department of Medical Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States. (Sabel M.S., msabel@umich.edu) Department of Surgery, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States. CORRESPONDENCE ADDRESS M.S. Sabel, Department of Surgery, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States. Email: msabel@umich.edu SOURCE Cancer (2006) 107:10 (2346-2351). Date of Publication: 15 Nov 2006 ISSN 0008-543X 1097-0142 (electronic) BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. The treatment of breast cancer requires a multidisciplinary approach, and patients are often referred to a multidisciplinary cancer clinic. The purpose of the current study was to evaluate the impact of this approach on the surgical management of breast cancer. METHODS. The medical records of 149 consecutive patients referred to a multidisciplinary breast cancer clinic over a 1-year period with a diagnosis of breast cancer were reviewed retrospectively for alterations in radiologic, pathologic, surgical, and medical interpretations and the effect that these alterations had on recommendations for surgical management. RESULTS. A review of the imaging studies resulted in changes in interpretations in 67 of the 149 patients studied (45%). This resulted in a change in surgical management in 11% of patients. Review of the pathology resulted in changes in the interpretation for 43 of the 149 patients (29%). Thirteen patients (9%) had surgical management changes made solely as a result of pathologic reinterpretation. In 51 patients (34%), a change in surgical management was recommended after discussion with the surgeons, medical oncologists, and radiation oncologists that was not based on reinterpretation of the radiologic or pathologic findings. Overall, a second evaluation of patients referred to a multidisciplinary tumor board led to changes in the recommendations for surgical management in 77 of 149 of those patients studied (52%). CONCLUSIONS. The changes in management stemmed from differences in mammographic interpretation, pathologic interpretation, and evaluation by medical and radiation oncologists and surgical breast specialists. Multidisciplinary review can provide patients with useful additional information when making difficult treatment decisions. © 2006 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) EMTREE MEDICAL INDEX TERMS consultation decision support system diagnostic imaging human image analysis major clinical study mastectomy medical decision making patient referral priority journal review surgeon teamwork treatment planning EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006560530 MEDLINE PMID 16998942 (http://www.ncbi.nlm.nih.gov/pubmed/16998942) PUI L44748516 DOI 10.1002/cncr.22266 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.22266 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 456 TITLE Prophylactic mastectomy in women at high risk for breast and ovarian cancer: Qualitative analysis of the decision making process and long-term satisfaction of two women carrying a BRCA1-mutation ORIGINAL (NON-ENGLISH) TITLE Prophylaktische chirurgie bei brust- und eierstockkrebsrisiko: Qualitative analyse des entscheidungsprozesses und der langzeitzufriedenheit zweier BRCA1-mutationsträgerinnen AUTHOR NAMES Vodermaier A. Bauerfeind I. Untch M. Nestle-Krämling C. AUTHOR ADDRESSES (Vodermaier A., Andrea.Vodermaier@med.uni-muenchen.de; Bauerfeind I.; Untch M.) Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Großhadern, Ludwig-Maximilians-Universität München, München, Germany. (Nestle-Krämling C.) Universitäts-Frauenklinik, Heinrich-Heine-Universität Düsseldorf, . (Vodermaier A., Andrea.Vodermaier@med.uni-muenchen.de) Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany. CORRESPONDENCE ADDRESS A. Vodermaier, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Großhadern, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany. Email: Andrea.Vodermaier@med.uni-muenchen.de SOURCE PPmP Psychotherapie Psychosomatik Medizinische Psychologie (2006) 56:9-10 (351-361). Date of Publication: September/October 2006 ISSN 0937-2032 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. ABSTRACT Purpose: Bilateral prophylactic mastectomy and oophorectomy are currently the most effective prevention options for female carriers of the BRCA1 or BRCA2 gene. However, especially the mastectomy procedure is very invasive and is chosen rarely among high risk women in Germany. Little is known about how women cope with this surgery and their long-term satisfaction. Methods: Face-to-face interviews were conducted with two BRCA1 mutation carriers, who had undergone prophylactic mastectomy in their twenties 9 and 16 years ago. The process of decision making and long-term satisfaction were analysed using Mayring's qualitative content analysis. Results: Both high risk women had a significant family history of breast and ovarian cancer. They were repeatedly confronted with uncontrollable courses of disease in their relatives who died of breast cancer between the age of 20 and 30 and left small children behind. Although both women experienced different decision making and peri- and post-operative complications, both were satisfied with the decision for prophylactic surgery and showed no regret. Discussion: Deciding to obtain genetic testing pushed women towards further decision making concerning prophylactic surgery in case they carry a mutation. Information about carrier status reduced uncertainty even if the result was adverse. Both high risk women experienced a decrease in cancer related anxiety which may have heightened tolerance for quality of life related impairments. Implications for counseling are described. © Georg Thieme Verlag KG Stuttgart. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer ovary cancer EMTREE MEDICAL INDEX TERMS adult anamnesis article cancer risk clinical article disease course female gene mutation heterozygote human long term care mastectomy medical decision making mortality patient satisfaction perioperative period postoperative complication (complication) priority journal prophylaxis qualitative analysis EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Obstetrics and Gynecology (10) Cancer (16) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2006553682 MEDLINE PMID 16804803 (http://www.ncbi.nlm.nih.gov/pubmed/16804803) PUI L44726944 DOI 10.1055/s-2006-940007 FULL TEXT LINK http://dx.doi.org/10.1055/s-2006-940007 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 457 TITLE Entertainment education for informed breast cancer treatment decisions in low-literate women: Development and initial evaluation of a patient decision aid AUTHOR NAMES Jibaja-Weiss M.L. Volk R.J. Granchi T.S. Neff N.E. Spann S.J. Aoki N. Robinson E.K. Friedman L.C. Beck J.R. AUTHOR ADDRESSES (Jibaja-Weiss M.L., mariaj@bcm.edu; Volk R.J.; Neff N.E.; Spann S.J.) Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States. (Granchi T.S.) Department of Surgery, Baylor College of Medicine, Houston, TX, United States. (Friedman L.C.) Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States. (Aoki N.) School of Health Information Sciences, University of Texas Health Science Center, Houston, TX, United States. (Aoki N.) Center for Health Service, Outcomes Research and Development, Tokyo, Japan. (Robinson E.K.) Department of Surgery, University of Texas, Houston, TX, United States. (Beck J.R.) Office of the Vice President for Information Services, Fox Chase Cancer Center, Philadelphia, PA, United States. (Jibaja-Weiss M.L., mariaj@bcm.edu) Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX 77098, United States. CORRESPONDENCE ADDRESS M.L. Jibaja-Weiss, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX 77098, United States. Email: mariaj@bcm.edu SOURCE Journal of Cancer Education (2006) 21:3 (133-139). Date of Publication: Fall 2006 ISSN 0885-8195 BOOK PUBLISHER Routledge, 4 Park Square, Milton Park, Abingdon, Oxfordshire, United Kingdom. ABSTRACT Background. We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. Method. We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. Results. Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. Conclusion. The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer therapy literature patient decision making patient education EMTREE MEDICAL INDEX TERMS article cancer surgery ethnicity female human human computer interaction learning major clinical study patient satisfaction priority journal software EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007120207 MEDLINE PMID 17371175 (http://www.ncbi.nlm.nih.gov/pubmed/17371175) PUI L46360655 DOI 10.1207/s15430154jce2103_8 FULL TEXT LINK http://dx.doi.org/10.1207/s15430154jce2103_8 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 458 TITLE Decision aids in routine practice: lessons from the breast cancer initiative. AUTHOR NAMES Silvia K.A. Sepucha K.R. AUTHOR ADDRESSES (Silvia K.A.; Sepucha K.R.) Health Decision Research Unit, Massachusetts General Hospital, Boston, MA 02114, USA. CORRESPONDENCE ADDRESS K.A. Silvia, Health Decision Research Unit, Massachusetts General Hospital, Boston, MA 02114, USA. SOURCE Health expectations : an international journal of public participation in health care and health policy (2006) 9:3 (255-264). Date of Publication: Sep 2006 ISSN 1369-6513 ABSTRACT BACKGROUND: Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. OBJECTIVE: To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. CONCLUSIONS: It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) decision support system EMTREE MEDICAL INDEX TERMS adult article clinical trial feasibility study female health center human interview multicenter study psychological aspect university hospital LANGUAGE OF ARTICLE English MEDLINE PMID 16911140 (http://www.ncbi.nlm.nih.gov/pubmed/16911140) PUI L44984791 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 459 TITLE Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions. AUTHOR NAMES Jibaja-Weiss M.L. Volk R.J. Friedman L.C. Granchi T.S. Neff N.E. Spann S.J. Robinson E.K. Aoki N. Robert Beck J. AUTHOR ADDRESSES (Jibaja-Weiss M.L.; Volk R.J.; Friedman L.C.; Granchi T.S.; Neff N.E.; Spann S.J.; Robinson E.K.; Aoki N.; Robert Beck J.) Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA. CORRESPONDENCE ADDRESS M.L. Jibaja-Weiss, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA. Email: mariaj@bcm.tmc.edu SOURCE Health expectations : an international journal of public participation in health care and health policy (2006) 9:3 (218-231). Date of Publication: Sep 2006 ISSN 1369-6513 ABSTRACT OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) decision support system educational status female EMTREE MEDICAL INDEX TERMS adult aged article human middle aged patient education psychological aspect time LANGUAGE OF ARTICLE English MEDLINE PMID 16911136 (http://www.ncbi.nlm.nih.gov/pubmed/16911136) PUI L44984787 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 460 TITLE A randomized controlled trial of a decision aid for women at increased risk of ovarian cancer AUTHOR NAMES Tiller K. Meiser B. Gaff C. Kirk J. Dudding T. Phillips K.-A. Friedlander M. Tucker K. AUTHOR ADDRESSES (Tiller K., Kerry.Tiller@sesiahs.health.NSW.gov.au; Meiser B.; Friedlander M.; Tucker K.) Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia. (Tiller K., Kerry.Tiller@sesiahs.health.NSW.gov.au; Tucker K.) Department of Psychology, Macquarie University, Sydney, NSW, Australia. (Tiller K., Kerry.Tiller@sesiahs.health.NSW.gov.au; Meiser B.; Friedlander M.; Tucker K.) Prince of Wales Clinical School, University of NSW, Sydney, NSW, Australia. (Gaff C.) Genetic Health Services, Vic., Australia. (Gaff C.) Familial Cancer Center, Royal Melbourne Hospital, Melbourne, Vic., Australia. (Kirk J.) Familial Cancer Service, Westmead Hospital, Sydney, NSW, Australia. (Dudding T.) Hunter Family Cancer Service, Hunter Genetics, University of Newcastle, Australia. (Phillips K.-A.) Division of Hematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Vic., Australia. (Tiller K., Kerry.Tiller@sesiahs.health.NSW.gov.au) Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia. CORRESPONDENCE ADDRESS K. Tiller, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia. Email: Kerry.Tiller@sesiahs.health.NSW.gov.au SOURCE Medical Decision Making (2006) 26:4 (360-372). Date of Publication: July/August 2006 ISSN 0272-989X 1552-681X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Purpose. To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. Methods. This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. Participants. 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. Outcome measures. Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. Results. Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. Conclusion. This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ovary cancer EMTREE MEDICAL INDEX TERMS adult article breast cancer cancer risk clinical trial colorectal cancer controlled clinical trial controlled study decision aid decision making distress syndrome family history female follow up human major clinical study randomized controlled trial risk management scientific literature EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006336447 MEDLINE PMID 16855125 (http://www.ncbi.nlm.nih.gov/pubmed/16855125) PUI L44050841 DOI 10.1177/0272989X06290486 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X06290486 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 461 TITLE Pharmacoeconomic aspects of adjuvant anastrozole or tamoxifen in breast cancer: A Slovenian perspective AUTHOR NAMES Piskur P. Sonc M. Cufer T. Borstnar S. Mrhar A. AUTHOR ADDRESSES (Piskur P.; Mrhar A.) Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia. (Sonc M.; Cufer T.; Borstnar S., sborstnar@onko-i.si) Institute of Oncology, Ljubljana, Slovenia. (Borstnar S., sborstnar@onko-i.si) Institute of Oncology, Zaloška 2, 1000 Ljubljana, Slovenia. CORRESPONDENCE ADDRESS S. Borstnar, Institute of Oncology, Zaloška 2, 1000 Ljubljana, Slovenia. Email: sborstnar@onko-i.si SOURCE Anti-Cancer Drugs (2006) 17:6 (719-724). Date of Publication: July 2006 ISSN 0959-4973 BOOK PUBLISHER Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom. ABSTRACT New treatment approaches that include the use of aromatase inhibitors in adjuvant breast cancer management are associated with higher efficacy and increased drug costs. Our aim was to calculate the difference in total costs of care associated with two therapeutic options, anastrozole and tamoxifen, from the perspective of a healthcare provider. The cost of care and a decision tree analysis were used in this assessment. The efficacy of both drugs in terms of relapse rate was obtained from an ATAC (Arimidex, Tamoxifen Alone or in Combination) trial after the median observational time of 68 months. The total sum of all direct healthcare costs over a 60-month period was 14 438 and 8009 Euros per person in the anastrozole and tamoxifen arm, respectively. Despite higher total costs of care associated with anastrozole, the drug cost ratio of anastrozole/tamoxifen=8.1/1 converted to a ratio of only 1.75/1 in favor of tamoxifen when costs of recurrence and adverse events were included. The total costs of care, including disease recurrences and adverse event management obtained in our analysis were similar to total costs of care values for other surveys, which lead us to believe that anastrozole is also a cost-effective alternative to tamoxifen in Slovenia. © 2006 Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) anastrozole (adverse drug reaction, drug combination, drug comparison, drug therapy, pharmacoeconomics) tamoxifen (adverse drug reaction, drug combination, drug comparison, drug therapy, pharmacoeconomics) EMTREE DRUG INDEX TERMS antiestrogen (adverse drug reaction, drug combination, drug comparison, drug therapy, pharmacoeconomics) aromatase inhibitor (adverse drug reaction, drug combination, drug comparison, drug therapy, pharmacoeconomics) exemestane (drug therapy) letrozole (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, drug therapy, radiotherapy, surgery) cancer adjuvant therapy drug cost health care cost EMTREE MEDICAL INDEX TERMS ambulatory care arthralgia (side effect) article cancer chemotherapy cancer radiotherapy cancer recurrence (complication, diagnosis, disease management, drug therapy, radiotherapy) cerebrovascular accident (disease management, side effect) computer assisted tomography cost effectiveness analysis decision theory deep vein thrombosis (disease management, side effect) diagnostic imaging early cancer (diagnosis, disease management, drug therapy, radiotherapy, surgery) female gynecologic disease (disease management, side effect, surgery) home care hospital care human hysterectomy major clinical study mammography mastectomy multimodality cancer therapy postmenopause preoperative evaluation priority journal Slovenia spine fracture (disease management, side effect) ultrasound DRUG TRADE NAMES arimidex CAS REGISTRY NUMBERS anastrozole (120511-73-1) exemestane (107868-30-4) letrozole (112809-51-5) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006403581 MEDLINE PMID 16917219 (http://www.ncbi.nlm.nih.gov/pubmed/16917219) PUI L44265873 DOI 10.1097/01.cad.0000215057.47695.db FULL TEXT LINK http://dx.doi.org/10.1097/01.cad.0000215057.47695.db COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 462 TITLE Institutional review of free TRAM flap breast reconstruction AUTHOR NAMES Knight M.A.K. Nguyen IV D.T. Kobayashi M.R. Evans G.R.D. AUTHOR ADDRESSES (Knight M.A.K.; Nguyen IV D.T.; Kobayashi M.R.; Evans G.R.D., GEvans@uci.edu) Aesthetic and Plastic Surgery Institute, University of California, Irvine, CA, United States. (Evans G.R.D., GEvans@uci.edu) 200 S. Manchester, Orange, CA 92868, United States. CORRESPONDENCE ADDRESS G.R.D. Evans, 200 S. Manchester, Orange, CA 92868, United States. Email: GEvans@uci.edu SOURCE Annals of Plastic Surgery (2006) 56:6 (593-598). Date of Publication: June 2006 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT INTRODUCTION: A 10-year experience with breast reconstruction in a university hospital was recently reviewed. The purpose of this study was to determine the subtypes of breast reconstructive procedures and to evaluate the frequency and change in technique over time of free TRAM (transverse rectus abdominis muscle) flap breast reconstruction performed at one institution. Trends in the development of the procedure over this period were also reviewed. MATERIALS & METHODS: Between November 1994 and September 2004, a 10-year retrospective chart review was conducted. The indications for mastectomy and reconstruction were determined. The median age was 48 (range 31-66). The range of follow-up was 2 to 71 months, with a median of 19.5 months. The mean follow-up was 23.5 months. Outcome data were grouped into 2 consecutive 5-year periods (period 1: 1994-1998; period 2: 1999-2004) and evaluated for changes over time in techniques and outcome. Statistical analysis (Decision Analyst, Inc., STATS Statistics software, version 1.1, 1998) was performed using the difference between 2 proportions module to assess the probability of a significant difference in the data for period 1 and period 2 parameters. RESULTS: Over a 10-year period, 117 patients underwent breast reconstruction. This consisted of 12 pedicle procedures (11.3%), including 1 bipedicle flap (0.9%) and 2 bilateral pedicle procedures (1.8%). There were 3 latissimus dorsi pedicle flaps (2.8%). Sixteen patients (15.1%) received tissue expander or implant reconstructions. Of the 117 patients, 79 underwent free flap breast reconstruction. Of the 79 free-flap patients, 22 (27.8%) had bilateral procedures, for a total of 101 free flaps performed in these 79 patients. Fifty-two patients underwent immediate reconstruction (65.8%) and 25 were delayed (31.6%) reconstructions using either deep inferior epigastric artery perforator (DIEP) flaps (4 = 3.9%) or free TRAM flaps (97 = 96.0%). A muscle-sparing technique was used in 43 of the 97 free TRAM flaps (44.3%). The preferred vascular inflow was the internal mammary artery, which was used in 66 out of 101 flaps (65.3%). The rate of anastomotic revision (arterial and venous) was 4.9%. The majority of cases used a 2.5-mm venous coupler (65.3%). In 2 of the free TRAM cases, there was insufficient volume to establish the patients preexisting volume. Therefore, at the patient's request, immediate implants were used to augment the reconstruction. The average hospital stay was 8.13 days, and the average intensive care stay was 4.59 days. When assessed for trends over time, we noted a reduction in our hospital length of stay and our ICU length of stay. CONCLUSION: The experience with free tissue breast reconstruction reveals predominant use of the TRAM flap. This is justified by the reliability of this flap and the advances in achieving esthetic breast reconstruction. Additionally, we have begun performing DIEP free-flap reconstructions. Our clinical practice has evolved concurrent with standards of care, as noted by the increase in use of muscle-sparing techniques and the reduction in the use of dextran. We do not routinely use therapeutic anticoagulation in our cases. Our hospital length of stay and average intensive care length of stay have also decreased over time, consistent with a system-wide effort to increase the efficiency of healthcare delivery. Copyright © 2006 by Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS dextran EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction myocutaneous flap transverse rectus abdominis muscle flap EMTREE MEDICAL INDEX TERMS adult aged anastomosis anticoagulation blood flow deep inferior epigastric perforator flap female follow up free tissue graft health care delivery human intensive care internal mammary artery length of stay major clinical study mastectomy outcome assessment priority journal reliability retrospective study review surgical technique university hospital CAS REGISTRY NUMBERS dextran (87915-38-6, 9014-78-2) EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006266558 MEDLINE PMID 16721068 (http://www.ncbi.nlm.nih.gov/pubmed/16721068) PUI L43833031 DOI 10.1097/01.sap.0000202226.92967.f0 FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000202226.92967.f0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 463 TITLE A two-year prospective analysis of trunk function in TRAM breast reconstructions AUTHOR NAMES Alderman A.K. Kuzon Jr. W.M. Wilkins E.G. AUTHOR ADDRESSES (Alderman A.K., aalder@umich.edu) Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, United States. (Kuzon Jr. W.M.; Wilkins E.G.) CORRESPONDENCE ADDRESS A.K. Alderman, Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, United States. Email: aalder@umich.edu SOURCE Plastic and Reconstructive Surgery (2006) 117:7 (2131-2138). Date of Publication: June 2006 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Functional outcomes in breast reconstruction are important quality measures and aid in patients' decision-making process. To address the concerns of abdominal wall morbidity with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions, the authors prospectively evaluated the long-term effects of postmastectomy breast reconstruction on trunk function using objective clinical measures. METHODS: Using a multicenter prospective cohort design, they recruited women undergoing first-time immediate or delayed breast reconstructions from 12 centers and 23 plastic surgeons. Trunk functional data, objectively measured with Cybex machines, for patients with an expander/implant, pedicle TRAM, and free TRAM reconstructions were evaluated preoperatively and at postoperative years 1 and 2 in 183 patients. The effects of procedure type, timing, and laterality on trunk peak torque and range of motion were analyzed using linear regression. RESULTS: At 2 years postoperatively, procedure type, timing, and laterality did not significantly affect the range of motion for trunk flexion and extension. Peak torque for trunk flexion at year 2 was significantly decreased in patients with TRAM compared with expander/implant reconstructions (p < 0.05), with a 6 to 19 percent decrease in flexion peak torque. However, no significant difference in flexion peak torque was found between patients with free and pedicle TRAM reconstructions. CONCLUSIONS: The authors found that (1) breast cancer patients with TRAM reconstructions had a less than 20 percent long-term deficit in trunk flexion peak torque and (2) there was no significant difference in trunk function between patients receiving pedicle and free TRAM reconstructions. Copyright ©2006 by the American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction myocutaneous flap transverse rectus abdominis musculocutaneous flap EMTREE MEDICAL INDEX TERMS adult analytic method article cohort analysis controlled study female human implant linear regression analysis major clinical study mastectomy measurement plastic surgery postoperative period preoperative period priority journal prospective study surgeon EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006427481 MEDLINE PMID 16772906 (http://www.ncbi.nlm.nih.gov/pubmed/16772906) PUI L44324244 DOI 10.1097/01.prs.0000218176.40705.5a FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000218176.40705.5a COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 464 TITLE Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation AUTHOR NAMES Anderson K. Jacobson J.S. Heitjan D.F. Zivin J.G. Hershman D. Neugut A.I. Grann V.R. AUTHOR ADDRESSES (Neugut A.I.; Grann V.R., VRG2@columbia.edu) Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States. (Anderson K.) Medical School Duluth, University of Minnesota, Duluth, School of Medicine 113, 1035 University Drive, Duluth, MN 55812-3031, United States. (Jacobson J.S.; Zivin J.G.) Columbia University, 722 West 168th Street, New York, NY 10032, United States. (Heitjan D.F.) Department of Biostatistics and Epidemiology, University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104-6021, United States. (Hershman D.) Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, New York, NY 10032, United States. CORRESPONDENCE ADDRESS V.R. Grann, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, United States. Email: VRG2@columbia.edu SOURCE Annals of Internal Medicine (2006) 144:6 (397-406). Date of Publication: 21 Mar 2006 ISSN 0003-4819 BOOK PUBLISHER American College of Physicians, 190 N. Indenpence Mall West, Philadelphia, United States. ABSTRACT Background: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone. Objective: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance. Design: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. Data Sources: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services). Target Population: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age. Time Horizon: Lifetime. Perspective: Health policy, societal. Interventions: Tamoxifen, oral contraceptives, bilateral salpingooophorectomy, mastectomy, both surgeries, or surveillance. Outcome Measures: Cost-effectiveness. Results of Base-Case Analysis: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of $2352 per life-year for BRCA1 and $100 per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of $2281 per life-year for BRCA2. Results of Sensitivity Analysis: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to $73 755 per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes. Limitations: Results are dependent on the accuracy of model assumptions. Conclusion: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively. © 2006 American College of Physicians. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) oral contraceptive agent (drug therapy, oral drug administration) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, drug therapy, epidemiology, prevention, surgery) ovary cancer (disease management, drug therapy, epidemiology, prevention, surgery) EMTREE MEDICAL INDEX TERMS adult article cancer epidemiology cancer incidence cancer mortality cancer prevention controlled study cost effectiveness analysis female funding gene mutation health care cost health care organization health care quality human major clinical study mastectomy medical literature Monte Carlo method outcome assessment penetrance priority journal probability quality adjusted life year salpingooophorectomy sensitivity analysis CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Internal Medicine (6) Obstetrics and Gynecology (10) Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007243614 MEDLINE PMID 16549852 (http://www.ncbi.nlm.nih.gov/pubmed/16549852) PUI L46768161 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 465 TITLE Towards quantifying the aesthetic outcomes of breast cancer treatment: assessment of surgical scars. AUTHOR NAMES Kim M.S. Rodney W.N. Peng J. Reece G.P. Markey M.K. AUTHOR ADDRESSES (Kim M.S.; Rodney W.N.; Peng J.; Reece G.P.; Markey M.K.) Department of Biomedical Engineering, The University of Texas at Austin, TX, USA. CORRESPONDENCE ADDRESS M.S. Kim, Department of Biomedical Engineering, The University of Texas at Austin, TX, USA. SOURCE AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium (2005) (1009). Date of Publication: 2005 ISSN 1559-4076 (electronic) ABSTRACT Our long-term goal is to develop decision aids that will improve breast cancer treatment by explicitly taking aesthetics in the consideration. Essentially all breast cancer treatment involves surgery, which inevitably leaves scars. However, the extent and type of scarring is not the same for different surgeries (e.g., different forms of reconstruction.) We present our preliminary experiences in using image processing techniques to quantify scar characteristics in clinical photographs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (surgery) esthetics image processing scar EMTREE MEDICAL INDEX TERMS article classification decision support system female human mastectomy observer variation pilot study LANGUAGE OF ARTICLE English MEDLINE PMID 16779296 (http://www.ncbi.nlm.nih.gov/pubmed/16779296) PUI L45004413 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 466 TITLE Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations AUTHOR NAMES Armstrong K. Weber B. Ubel P.A. Peters N. Holmes J. Schwartz J.S. AUTHOR ADDRESSES (Armstrong K., karmstro@mail.med.upenn.edu) 1204 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, United States. (Weber B.; Ubel P.A.; Peters N.; Holmes J.; Schwartz J.S.) CORRESPONDENCE ADDRESS K. Armstrong, 1204 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, United States. Email: karmstro@mail.med.upenn.edu SOURCE Journal of Clinical Oncology (2005) 23:36 (9319-9328). Date of Publication: 2005 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. Patients and Methods: This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. Results: Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. Conclusion: The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline. © 2005 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE DRUG INDEX TERMS raloxifene tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, etiology) cancer survival cancer therapy medical decision making ovary cancer (etiology) EMTREE MEDICAL INDEX TERMS adult anxiety article cancer incidence cancer risk clinical article clinical trial controlled clinical trial controlled study female follow up gene mutation hormone substitution human mastectomy outcome assessment ovariectomy patient satisfaction priority journal randomized controlled trial survival rate CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007090138 PUI L46260190 DOI 10.1200/JCO.2005.06.119 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2005.06.119 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 467 TITLE Information giving and decision-making in patients with advanced cancer: A systematic review AUTHOR NAMES Gaston C.M. Mitchell G. AUTHOR ADDRESSES (Gaston C.M., christine.gaston@nhs.net) Cornford House Surgery, 364 Cherry Hinton Road, Cambridge CB2 4PH, United Kingdom. (Mitchell G.) Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia. CORRESPONDENCE ADDRESS C.M. Gaston, Cornford House Surgery, 364 Cherry Hinton Road, Cambridge CB2 4PH, United Kingdom. Email: christine.gaston@nhs.net SOURCE Social Science and Medicine (2005) 61:10 (2252-2264). Date of Publication: November 2005 ISSN 0277-9536 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement. © 2005 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) advanced cancer information dissemination medical decision making patient information EMTREE MEDICAL INDEX TERMS age distribution audiovisual equipment breast cancer consultation education human patient satisfaction prediction prostate cancer questionnaire randomization reliability review sex difference systematic review EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005404490 MEDLINE PMID 15922501 (http://www.ncbi.nlm.nih.gov/pubmed/15922501) PUI L41262516 DOI 10.1016/j.socscimed.2005.04.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.socscimed.2005.04.015 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 468 TITLE Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information AUTHOR NAMES Peele P.B. Siminoff L.A. Xu Y. Ravdin P.M. AUTHOR ADDRESSES (Peele P.B., peele@pitt.edu; Xu Y.) Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States. (Siminoff L.A.) Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States. (Ravdin P.M.) Department of Medicine, University of Texas Health Science Center, San Antonio, TX, United States. (Peele P.B., peele@pitt.edu) 130 DeSoto Street, Pittsburgh, PA 15261, United States. CORRESPONDENCE ADDRESS P.B. Peele, 130 DeSoto Street, Pittsburgh, PA 15261, United States. Email: peele@pitt.edu SOURCE Medical Decision Making (2005) 25:3 (301-307). Date of Publication: May/June 2005 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Objective. Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer. Method. 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). Results. Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P < 0.01). Conclusions. This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) hormone (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy) cancer adjuvant therapy EMTREE MEDICAL INDEX TERMS adult age article clinical trial consultation controlled clinical trial controlled study disease severity education female human major clinical study marriage medical decision making patient information practice guideline race randomized controlled trial EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005227494 MEDLINE PMID 15951457 (http://www.ncbi.nlm.nih.gov/pubmed/15951457) PUI L40696279 DOI 10.1177/0272989X05276851 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X05276851 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 469 TITLE Aid in decision making for the choice of therapy for patients with breast cancer: Prognostic and predictive factors ORIGINAL (NON-ENGLISH) TITLE Entscheidungshilfen bei der therapiewahl für patientinnen mit mammakarzinom: Prognose- und prädiktivfaktoren AUTHOR NAMES Fasching P.A. Lux M.P. Beckmann K. Strick R. Beckmann M.W. AUTHOR ADDRESSES (Fasching P.A.; Lux M.P.; Beckmann K.; Strick R.; Beckmann M.W., direktion@gyn.imed.uni-erlangen.de) Frauenklinik, Universitätsklinikum Erlangen, . (Beckmann M.W., direktion@gyn.imed.uni-erlangen.de) Frauenklinik, Universitätsklinikum Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany. CORRESPONDENCE ADDRESS M.W. Beckmann, Frauenklinik, Universitätsklinikum Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany. Email: direktion@gyn.imed.uni-erlangen.de SOURCE Gynakologe (2005) 38:5 (388-397). Date of Publication: May 2005 ISSN 0017-5994 ABSTRACT Therapeutic decisions for patients with breast cancer are commonly based on the risk estimation of recurrence and death. Several prognostic markers such as tumor size, axillary lymph node status, hormonal receptor status, vessel invasion, grading and HER2/neu-status, which help to predict the response to a specific therapy, are used in planning further treatment. Currently, estrogen receptor status is the strongest predictive factor for a therapy with tamoxifen. For chemotherapy, some predictive factors are also known. The plasminogen activator uPA and his inhibitor PAI-1 can predict the response to chemotherapy to some degree. Since the publication of large scale gene expression profiles of frozen tumor tissues, patients with a good prognosis can be differentiated from patients with a worse prognosis. Studies evaluating the predictive value of gene expression profiles are ongoing. Other prognostic models, using paraffin embedded tumor material, can also provide valid prognostic information. Furthermore, computer models can calculate the patient's individual risk of recurrence and death by comparison with large datasets of similar patients. This software is already in use and can help to estimate therapeutic effect. All of these developments emphasize the increasing importance of prognostic and predictive factors in the management of patients with breast cancer. They will become indispensable for planning an individual therapy for the breast cancer patient. © Springer Medizin Verlag 2005. EMTREE DRUG INDEX TERMS epidermal growth factor receptor 2 estrogen receptor hormone receptor paraffin plasminogen activator tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy) cancer therapy medical decision making treatment planning EMTREE MEDICAL INDEX TERMS article axillary lymph node cancer chemotherapy cancer grading cancer mortality cancer recurrence computer model frozen section gene expression profiling human prediction prognosis publication risk assessment software tumor invasion tumor volume CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) plasminogen activator (9039-53-6) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2005289224 PUI L40895734 DOI 10.1007/s00129-005-1680-6 FULL TEXT LINK http://dx.doi.org/10.1007/s00129-005-1680-6 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 470 TITLE The GRAIDS Trial: The development and evaluation of computer decision support for cancer genetic risk assessment in primary care AUTHOR NAMES Emery J. AUTHOR ADDRESSES (Emery J., jemery@cyllene.uwa.edu.au) School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA, Australia. (Emery J., jemery@cyllene.uwa.edu.au) Department of General Practice, University of Western Australia, 328 Stirling Highway, Perth, WA 6010, Australia. CORRESPONDENCE ADDRESS J. Emery, Department of General Practice, University of Western Australia, 328 Stirling Highway, Perth, WA 6010, Australia. Email: jemery@cyllene.uwa.edu.au SOURCE Annals of Human Biology (2005) 32:2 (218-227). Date of Publication: March/April 2005 ISSN 0301-4460 1464-5033 (electronic) BOOK PUBLISHER Taylor and Francis Ltd. ABSTRACT The development and evaluation of computer decision support for the assessment of cancer genetic risk in primary care is reported with two series of studies described: the RAGs (Risk Assessment in Genetics) studies and the GRAIDS (Genetic Risk Assessment in an Intranet and Decision Support) Trial. In the GRAIDS Trial, 45 general practices in Eastern England have been recruited and randomised. Comparison practices attend an educational session and receive clinical guidelines about familial breast and colorectal cancer. In the intervention practices a lead clinician is trained in cancer genetics and use of the GRAIDS software. The GRAIDS software is a simple pedigree-drawing program that implements clinical guidelines for familial breast and colorectal cancer and presents individualised information about breast cancer risk in a range of formats. Outcome measures of the trial include: frequency of software use, practitioners' attitudes towards the software, total number of referrals to secondary care about familial cancer and the proportion that meet regional referral criteria, and a patient-centred measure of informed decision making. The family history will become an increasingly important tool in primary care to assess genetic risk. This research evaluates an approach to support high-quality advice about cancer genetics in primary care which could be applied more broadly as our understanding of complex disease genetics increases. © 2005 Taylor & Francis Group Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention) colorectal tumor (prevention) decision support system primary health care risk assessment EMTREE MEDICAL INDEX TERMS attitude to computers clinical trial conference paper controlled clinical trial controlled study education female genetics health personnel attitude human methodology outcome assessment randomized controlled trial United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, French, German, Spanish MEDLINE PMID 16096220 (http://www.ncbi.nlm.nih.gov/pubmed/16096220) PUI L40995625 DOI 10.1080/03014460500074921 FULL TEXT LINK http://dx.doi.org/10.1080/03014460500074921 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 471 TITLE Is adjuvant therapy for older patients with node (-) early breast cancer cost-effective? AUTHOR NAMES Naeim A. Keeler E.B. AUTHOR ADDRESSES (Naeim A., anaeim@mednet.ucla.edu) Division of Hematology-Oncology, UCLA Department of Medicine, 10945 Le Conte Ave., Suite 2345, B., . (Keeler E.B., emmett@rand.org) RAND School of Public Policy, Division of Health Services Research, 1200 Main St., S. Monica, C., . CORRESPONDENCE ADDRESS Division of Hematology-Oncology, UCLA Department of Medicine, 10945 Le Conte Ave., Suite 2345, B., . Email: anaeim@mednet.ucla.edu SOURCE Critical Reviews in Oncology/Hematology (2005) 53:1 (81-89). Date of Publication: January 2005 ISSN 1040-8428 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Node (-) breast cancer represents over 60% of cases in older women and currently there is a debate whether adjuvant therapy for these women is cost-effective. Evaluate if adjuvant treatment for early-stage node (-) breast cancer with hormone therapy, chemotherapy, or combination therapy is cost-effective in older patients. Decision-analysis modeling using life tables integrated the cost of treatment in dollars and impact in length and quality of life. The primary data sources were meta-analysis from the Early Breast Cancer Trialists' Collaborative Group and the Red Book Average Wholesale Price for drugs. The incremental cost-effectiveness of different treatment strategies were then compared and mapped graphically. Adjuvant therapy is cost-effective in 65-year-old women with early breast cancer. In a 75-year-old estrogen receptor, ER (+) patient, hormone therapy, specifically tamoxifen, is cost-effective, $19,530/QALY. In a 75-year-old ER (-) the use of chemotherapy (AC or CMF) or 85-year-old ER (+) the use of hormone therapy was only marginally cost-effective, $54,000-76,000/QALY, only if efficacy was assumed to be age-insensitive (similar to a 65-year-old woman). Decision-analytic models can help policy makers who are faced with decisions about whether to support adjuvant therapy in older breast cancer patients and also outline the important parameters that need to be considered in such a decision. © 2004 Elsevier Ireland Ltd. All rights reserved. EMTREE DRUG INDEX TERMS cyclophosphamide (drug combination, drug therapy, pharmacoeconomics) doxorubicin (drug combination, drug therapy, pharmacoeconomics) estrogen receptor fluorouracil (drug combination, drug therapy, pharmacoeconomics) methotrexate (drug combination, drug therapy, pharmacoeconomics) tamoxifen (drug combination, drug therapy, pharmacoeconomics) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, drug therapy) cost effectiveness analysis EMTREE MEDICAL INDEX TERMS article cancer chemotherapy cancer combination chemotherapy cancer hormone therapy drug cost health care cost human medical decision making model quality of life DRUG TRADE NAMES adriamycin CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) methotrexate (15475-56-6, 59-05-2, 7413-34-5) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004536241 MEDLINE PMID 15607936 (http://www.ncbi.nlm.nih.gov/pubmed/15607936) PUI L39656111 DOI 10.1016/j.critrevonc.2004.09.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.critrevonc.2004.09.001 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 472 TITLE Impact of BRCA1/BRCA2 counseling and testing on newly diagnosed breast cancer patients AUTHOR NAMES Schwartz M.D. Lerman C. Brogan B. Peshkin B.N. Halbert C.H. DeMarco T. Lawrence W. Main D. Finch C. Magnant C. Pennanen M. Tsangaris T. Willey S. Isaacs C. AUTHOR ADDRESSES (Schwartz M.D., schwartm@georgetown.edu) Georgetown University School of Medicine, Lombardi Comprehensive Cancer Center, Cancer Control, 2233 Wisconsin Ave, NW, Washington, DC 20007, United States. (Lerman C.; Brogan B.; Peshkin B.N.; Halbert C.H.; DeMarco T.; Lawrence W.; Main D.; Finch C.; Magnant C.; Pennanen M.; Tsangaris T.; Willey S.; Isaacs C.) CORRESPONDENCE ADDRESS M.D. Schwartz, Georgetown University School of Medicine, Lombardi Comprehensive Cancer Center, Cancer Control, 2233 Wisconsin Ave, NW, Washington, DC 20007, United States. Email: schwartm@georgetown.edu SOURCE Journal of Clinical Oncology (2004) 22:10 (1823-1829). Date of Publication: 2004 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Approximately 5% to 10% of newly diagnosed breast cancer patients carry a BRCA1 or BRCA2 mutation. Given these patients' high risk for contralateral breast cancer, bilateral mastectomy is increasingly considered a treatment option for newly diagnosed BRCA1/2 carriers. In the present study, we prospectively evaluated the impact on surgical decision-making of pretreatment genetic counseling and BRCA1/BRCA2 testing among breast cancer patients at high-risk for carrying a mutation. Patients and Methods: Participants were 194 newly diagnosed breast cancer patients who had not yet received definitive surgical treatment and who had at least a 10% prior probability of carrying a BRCA1/2 mutation. Participants were offered free genetic counseling and rapid BRCA1/2 testing. Primary analyses focused on the impact of BRCA1/2 test result on subsequent breast cancer surgical treatment. Results: Forty-eight percent of patients who were found to carry a BRCA1/2 mutation chose bilateral mastectomy as their definitive breast cancer surgery. In contrast, 24% of patients in whom no mutation was detected and 4% of test decliners opted for bilateral mastectomy. Additional predictors of bilateral mastectomy included patients' self-reports of physician recommendations for BRCA1/2 testing and bilateral mastectomy. Conclusion: This study highlights patient interest in and the technical feasibility of offering presurgery BRCA1/2 testing to high-risk patients. Most importantly, these results demonstrate that BRCA1/2 test results significantly affect patients' surgical decision-making. The availability of genetic counseling and testing could serve as a valuable aid to patient decision-making for newly diagnosed breast cancer patients at high-risk for carrying a mutation. © 2004 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) EMTREE MEDICAL INDEX TERMS article cancer surgery decision making gene mutation genetic counseling high risk patient human major clinical study mastectomy priority journal prospective study EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005350870 MEDLINE PMID 15067026 (http://www.ncbi.nlm.nih.gov/pubmed/15067026) PUI L41095172 DOI 10.1200/JCO.2004.04.086 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2004.04.086 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 473 TITLE Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: A decision analysis AUTHOR NAMES Armstrong K. Schwartz J.S. Randall T. Rubin S.C. Weber B. AUTHOR ADDRESSES (Armstrong K., karmstro@mail.med.upenn.edu) University of Pennsylvania, 1204 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, United States. (Schwartz J.S.; Randall T.; Rubin S.C.; Weber B.) CORRESPONDENCE ADDRESS K. Armstrong, University of Pennsylvania, 1204 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, United States. Email: karmstro@mail.med.upenn.edu SOURCE Journal of Clinical Oncology (2004) 22:6 (1045-1054). Date of Publication: 2004 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. Patients and Methods: A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. Results: In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to -0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (-0.79 to -1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. Conclusion: On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years. © 2004 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein BRCA2 protein EMTREE MEDICAL INDEX TERMS article cancer risk female gene mutation groups by age hormone substitution human life expectancy mastectomy ovariectomy priority journal probability sensitivity analysis statistical analysis EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005350735 MEDLINE PMID 14981106 (http://www.ncbi.nlm.nih.gov/pubmed/14981106) PUI L41095037 DOI 10.1200/JCO.2004.06.090 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2004.06.090 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 474 TITLE The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer AUTHOR NAMES Tseng J.F. Kronowitz S.J. Sun C.C. Perry A.C. Hunt K.K. Babiera G.V. Newman L.A. Singletary S.E. Mirza N.Q. Ames F.C. Meric-Bernstam F. Ross M.I. Feig B.W. Robb G.L. Kuerer H.M. AUTHOR ADDRESSES (Tseng J.F.; Perry A.C.; Hunt K.K.; Babiera G.V.; Singletary S.E.; Mirza N.Q.; Ames F.C.; Meric-Bernstam F.; Ross M.I.; Feig B.W.; Kuerer H.M., hkuerer@mdanderson.org) Department of Surgical Oncology, Univ. TX M. D. Anderson Cancer Ctr., Houston, TX, United States. (Kronowitz S.J.; Robb G.L.) Dept. of Plast. and Reconstr. Surg., Univ. TX M. D. Anderson Cancer Ctr., Houston, TX, United States. (Sun C.C.) Department of Gynecologic Oncology, Univ. TX M. D. Anderson Cancer Ctr., Houston, TX, United States. (Newman L.A.) Department of Surgery, University of Michigan, Ann Arbor, MI, United States. (Kuerer H.M., hkuerer@mdanderson.org) Department of Surgical Oncology, Univ. TX M. D. Anderson Cancer Ctr., 1515 Holcombe Boulevard, Houston, TX 77030, United States. CORRESPONDENCE ADDRESS H.M. Kuerer, Department of Surgical Oncology, Univ. TX M. D. Anderson Cancer Ctr., 1515 Holcombe Boulevard, Houston, TX 77030, United States. Email: hkuerer@mdanderson.org SOURCE Cancer (2004) 101:7 (1514-1523). Date of Publication: 1 Oct 2004 ISSN 0008-543X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. Multiple factors may influence whether patients undergo immediate breast reconstruction along with mastectomy for breast cancer. The authors investigated whether ethnicity was an independent predictor of immediate breast reconstruction. METHODS. The authors identified 1004 patients who underwent mastectomy for breast cancer during the period 2001-2002. The rates of immediate reconstruction among different ethnicities were evaluated using the chi-square test. Logistic regression was used to adjust for covariates, including age and disease stage. Medical records were analyzed to identify factors that influenced each patient's decision for or against immediate breast reconstruction. RESULTS. Three hundred seventy-six women (37.5%) underwent immediate breast reconstruction: This included 20.2% of African-American women, compared with 40.0% of white women, 42.0% of Hispanic women, 42.2% of Asian women, and 10.0% of Middle Eastern women (P < 0.001). The unadjusted odds ratio (OR) for immediate reconstruction for African-Americans versus whites was 0.38 (95% confidence interval [95% CI], 0.23-0.63; P < 0.001). After multivariate analysis, this disparity persisted, with an adjusted OR of 0.34 (95% CI, 0.18-0.62; P = 0.001). Asian women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.50; 95% CI, 0.24-1.04; P = 0.06). Hispanic women did not have immediate reconstruction rates that differed significantly from white women. Middle Eastern women had lower rates of immediate reconstruction compared with white women (adjusted OR, 0.08; 95% CI, 0.02-0.38; P = 0.002), but they had a corresponding increase in the rate of delayed reconstruction. In a stepwise analysis of the decision pathway to immediate reconstruction, it was found that African-American women were less likely to be offered referrals for reconstruction, were less likely to accept offered referrals, were less likely to be offered reconstruction, and were less likely to elect reconstruction if it was offered. CONCLUSIONS. African-American women underwent immediate breast reconstruction at significantly lower rates compared with white women, Hispanic women, and Asian women. After adjusting for covariates, including age and disease stage, African-American women and Asian women had lower rates of reconstruction compared with white women. The factors that contribute to these differences warrant further study. © 2004 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction ethnology mastectomy EMTREE MEDICAL INDEX TERMS adult African American aged article Asian decision making female Hispanic human logistic regression analysis major clinical study medical record Middle East multivariate analysis patient referral priority journal EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004427936 MEDLINE PMID 15378473 (http://www.ncbi.nlm.nih.gov/pubmed/15378473) PUI L39318896 DOI 10.1002/cncr.20529 FULL TEXT LINK http://dx.doi.org/10.1002/cncr.20529 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 475 TITLE Informed decision making: What is its role in cancer screening? AUTHOR NAMES Rimer B.K. Briss P.A. Zeller P.K. Chan E.C.Y. Woolf S.H. AUTHOR ADDRESSES (Rimer B.K., brimer@email.unc.edu) Dept. of Hlth. Behav./Hlth. Educ., School of Public Health, University of North Carolina, Chapel Hill, NC, United States. (Briss P.A.) Systematic Reviews Section, Community Guide Branch, Centers for Dis. Contr. and Prev., Atlanta, GA, United States. (Zeller P.K.) (Chan E.C.Y.) Div. of General Internal Medicine, Department of Medicine, Univ. Texas-Houston Hlth. Sci. Ctr., Houston, TX, United States. (Woolf S.H.) Department of Family Medicine, Virginia Commonwealth University, Richmond, VA, United States. (Rimer B.K., brimer@email.unc.edu) University of North Carolina, Lineberger Compreh. Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, United States. CORRESPONDENCE ADDRESS B.K. Rimer, University of North Carolina, Lineberger Compreh. Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, United States. Email: brimer@email.unc.edu SOURCE Cancer (2004) 101:5 SUPPL. (1214-1228). Date of Publication: 1 Sep 2004 ISSN 0008-543X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Interest in informed decision making (IDM) has grown in recent years. Greater patient involvement in decision making is consistent with recommendations to improve health care quality. This report provides an overview of IDM; clarifies the differences between IDM, shared decision making (SDM), and informed consent; and reviews the evidence to date about IDM for cancer screening. The authors also make recommendations for research. We define IDM as occurring when an individual understands the disease or condition being addressed and comprehends what the clinical service involves, including its benefits, risks, limitations, alternatives, and uncertainties; has considered his or her preferences and makes a decision consistent with them; and believes he or she has participated in decision making at the level desired. IDM interventions are used to facilitate informed decisions. The authors reviewed the evidence to date for IDM and cancer screening based primarily on published meta-analyses and a recent report for the Centers for Disease Control and Prevention's Guide to Community Preventive Services. IDM and SDM interventions, such as decision aids, result in improved knowledge, beliefs, risk perceptions, and combinations of these. Little or no evidence exists, however, regarding whether these interventions result in 1) participation in decision making at a level consistent with patient preferences or 2) effects on patient satisfaction with the decision-making process. These variables generally either were not assessed or were not reported in the articles reviewed. Results of interventions on uptake of screening were variable. After exposure to IDM/SDM interventions, most studies showed small decreases in prostate cancer screening, whereas four studies on breast and colorectal cancer screening showed small increases. Few data are available by which to evaluate current practices in cancer screening IDM. Patient participation in IDM should be facilitated for those who prefer it. More research is needed to assess the benefits of IDM/SDM interventions and to tailor interventions to individuals who are most likely to desire and benefit from them. There are many system barriers to IDM/SDM and few tools. More work is needed in this area as well. In addition, research is needed to learn how to incorporate IDM into ongoing clinical practice and to determine whether there are unintended negative consequences of IDM. © 2004 American Cancer Society. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer screening medical decision making EMTREE MEDICAL INDEX TERMS cancer patient evidence based medicine human perception practice guideline preventive medicine priority journal publication review risk treatment planning EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004357767 MEDLINE PMID 15316908 (http://www.ncbi.nlm.nih.gov/pubmed/15316908) PUI L39100415 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 476 TITLE Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: A decision analysis AUTHOR NAMES Armstrong K. Schwartz J.S. Randall T. Rubin S.C. Weber B. Naumann R.W. AUTHOR ADDRESSES (Naumann R.W.) Blumenthal Cancer Center, Charlotte, NC, United States. (Armstrong K.; Schwartz J.S.; Randall T.; Rubin S.C.; Weber B.) CORRESPONDENCE ADDRESS Blumenthal Cancer Center, Charlotte, NC, United States. SOURCE Women's Oncology Review (2004) 4:3 (201-202). Date of Publication: Sep 2004 ISSN 1473-3404 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE DRUG INDEX TERMS sex hormone (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hormone substitution life expectancy ovariectomy ovary cancer (drug therapy, etiology, prevention, surgery) EMTREE MEDICAL INDEX TERMS age article breast cancer (side effect, surgery) calculation cancer incidence cancer mortality cancer prevention clinical study cohort analysis controlled study epidemiological data gene mutation health status heart disease heterozygote hip fracture human hypothesis intermethod comparison mastectomy medical decision making probability risk assessment risk benefit analysis sensitivity analysis statistical significance surgical risk EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2005078691 PUI L40246395 DOI 10.1080/14733400412331312576 FULL TEXT LINK http://dx.doi.org/10.1080/14733400412331312576 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 477 TITLE Helping patients decide: Use of a decision aid for breast cancer surgery AUTHOR NAMES Whelan T. Levine M. Willan A. Horng M.S. AUTHOR ADDRESSES (Horng M.S.) Division of General Medicine, Brigham and Women's Hospital, Boston, MA, United States. (Whelan T.; Levine M.; Willan A.) CORRESPONDENCE ADDRESS Division of General Medicine, Brigham and Women's Hospital, Boston, MA, United States. SOURCE Journal of Clinical Outcomes Management (2004) 11:9 (546-550). Date of Publication: Sep 2004 ISSN 1079-6533 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, surgery) medical decision making EMTREE MEDICAL INDEX TERMS cancer staging cancer survival clinical study clinical trial conservative treatment consultation doctor patient relation general practitioner human mastectomy outcomes research patient information patient satisfaction short survey treatment planning EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2004441569 PUI L39369206 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 478 TITLE Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: A randomized trial AUTHOR NAMES Whelan T. Levine M. Willan A. Gafni A. Sanders K. Mirsky D. Chambers S. O'Brien M.A. Reid S. Dubois S. AUTHOR ADDRESSES (Whelan T., tim.whelan@hrcc.on.ca; Levine M.; Chambers S.; O'Brien M.A.) Department of Medicine, McMaster University, Hamilton, Ont., Canada. (Whelan T., tim.whelan@hrcc.on.ca; Levine M.; Willan A.; Gafni A.; Dubois S.) Dept. Clin. Epidemiol./Biostatist., McMaster University, Hamilton, Ont., Canada. (Sanders K.) Department of Surgery, McMaster University, Hamilton, Ont., Canada. (Whelan T., tim.whelan@hrcc.on.ca; Levine M.) Juravinski Cancer Centre, Hamilton, Ont., Canada. (Sanders K.; O'Brien M.A.; Reid S.) Hamilton Health Sciences, Hamilton, Ont., Canada. (Mirsky D.) Queensway-Carleton Hospital, Ottawa, Ont., Canada. (Whelan T., tim.whelan@hrcc.on.ca) Juravinski Cancer Centre, 699 Concession St, Hamilton, Ont. L8V 5C2, Canada. CORRESPONDENCE ADDRESS T. Whelan, Juravinski Cancer Centre, 699 Concession St, Hamilton, Ont. L8V 5C2, Canada. Email: tim.whelan@hrcc.on.ca SOURCE Journal of the American Medical Association (2004) 292:4 (435-441). Date of Publication: 28 Jul 2004 ISSN 0098-7484 BOOK PUBLISHER American Medical Association, 515 North State Street, Chicago, United States. ABSTRACT Context: The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences. Objective: To evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making. Design and Setting: A cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the decision aid or not in the surgical consultation. Patients received the decision aid or not based on the surgeon seen. Participants: Twenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002. Intervention: The decision board is a decision aid designed to help physicians inform their patients about different treatment options and to enable patients to express a preference for treatment. Main Outcome Measures: Patient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation. Results: Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs 58.7; P<.001), had less decisional conflict (1.40 vs 1.62, P=.02), and were more satisfied with decision making (4.50 vs 4.32, P=.05) following the consultation. Patients who used the decision board were more likely to choose BCT (94% vs 76%, P=.03). Conclusions: The decision board was helpful in improving communication and enabling women to make a choice regarding treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) EMTREE MEDICAL INDEX TERMS adult article clinical trial controlled clinical trial controlled study doctor patient relation female human major clinical study mastectomy medical decision making outcomes research patient satisfaction priority journal randomized controlled trial treatment planning EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004324920 MEDLINE PMID 15280341 (http://www.ncbi.nlm.nih.gov/pubmed/15280341) PUI L38988952 DOI 10.1001/jama.292.4.435 FULL TEXT LINK http://dx.doi.org/10.1001/jama.292.4.435 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 479 TITLE Breast cancer treatment in older women: Impact of the patient-physician interaction AUTHOR NAMES Maly R.C. Leake B. Silliman R.A. AUTHOR ADDRESSES (Maly R.C., rmaly@mednet.ucla.edu; Leake B.) Department of Family Medicine, David Geffen School of Medicine, Univ. of California at Los Angeles, Los Angeles, CA, United States. (Leake B.) School of Nursing, Univ. of California at Los Angeles, Los Angeles, CA, United States. (Silliman R.A.) Geriatrics Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States. (Silliman R.A.) Department of Epidemiology, Boston University School of Medicine, Boston, MA, United States. (Maly R.C., rmaly@mednet.ucla.edu) Department of Family Medicine, David Geffen Sch. of Med. at UCLA, Box 951683, Los Angeles, CA 90095, United States. CORRESPONDENCE ADDRESS R.C. Maly, Department of Family Medicine, David Geffen Sch. of Med. at UCLA, Box 951683, Los Angeles, CA 90095, United States. Email: rmaly@mednet.ucla.edu SOURCE Journal of the American Geriatrics Society (2004) 52:7 (1138-1145). Date of Publication: July 2004 ISSN 0002-8614 BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT OBJECTIVES: To assess the impact of the patient-physician interaction on breast cancer care in older women. DESIGN: Cross-sectional survey. SETTING: Los Angeles County, California. PARTICIPANTS: Two hundred twenty-two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment. MEASUREMENTS: Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables. RESULTS: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR) = 1.18, 95% confidence interval (CI) = 1.00-1.38), negatively predicted treatment delays (AOR = 0.80, 95% CI = 0.67-0.94), and positively predicted receipt of BCS (AOR = 1.29, 95% CI = 1.07-1.56). Age and ethnicity were not significant predictors in these models. CONCLUSION: One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer doctor patient relation elderly care EMTREE MEDICAL INDEX TERMS adult age aged breast surgery cancer diagnosis case mix conservative treatment decision making demography early diagnosis emotion ethnic group female health survey human major clinical study medical information multivariate logistic regression analysis population risk review social support socioeconomics statistical analysis statistical significance EMBASE CLASSIFICATIONS Cancer (16) Gerontology and Geriatrics (20) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004286833 MEDLINE PMID 15209652 (http://www.ncbi.nlm.nih.gov/pubmed/15209652) PUI L38869073 DOI 10.1111/j.1532-5415.2004.52312.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1532-5415.2004.52312.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 480 TITLE Predictors of patients' choices for breast-conserving therapy or mastectomy: A prospective study AUTHOR NAMES Molenaar S. Oort F. Sprangers M. Rutgers E. Luiten E. Mulder J. De Haes H. AUTHOR ADDRESSES (Molenaar S., J.Molenaar@AMC.UvA.NL; Oort F.; Sprangers M.; De Haes H.) Academic Medical Center, Department of Medical Psychology, PO Box 22 660, 1100 DD Amsterdam, Netherlands. (Rutgers E.) Netherlands Cancer Institute, Plesmanlaan 121, 1066 XC Amsterdam, Netherlands. (Luiten E.) St. Anna Hospital, PO Box 90, 5660 AB Geldrop, Netherlands. (Mulder J.) Medical Spectrum Twente, PO Box 50 000, 7500 KA Enschede, Netherlands. CORRESPONDENCE ADDRESS S. Molenaar, Academic Medical Center, Department of Medical Psychology, PO Box 22 660, 1100 DD Amsterdam, Netherlands. Email: J.Molenaar@AMC.UvA.NL SOURCE British Journal of Cancer (2004) 90:11 (2123-2130). Date of Publication: 1 Jun 2004 ISSN 0007-0920 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients' concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n = 88) or a decision aid (n = 92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n = 123); 28% chose MT (n = 49). Multivariate analysis showed that what patients perceived to be their surgeons' preference and the patients' concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did not influence treatment choice. The results of this study demonstrate that patients' concerns and their perceptions of the treatment preferences of the physicians are important factors in patients' decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients. © 2004 Cancer Research UK. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer conservative treatment mastectomy medical decision making EMTREE MEDICAL INDEX TERMS adult aged article cancer staging controlled study demography female human major clinical study multivariate analysis patient information priority journal quality of life tumor recurrence EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004287350 MEDLINE PMID 15150557 (http://www.ncbi.nlm.nih.gov/pubmed/15150557) PUI L38869715 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 481 TITLE Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: A cost-effectiveness analysis AUTHOR NAMES Thoma A. Veltri K. Khuthaila D. Rockwell G. Duku E. AUTHOR ADDRESSES (Thoma A., athoma@mcmaster.ca; Veltri K.; Khuthaila D.; Rockwell G.; Duku E.) (Thoma A., athoma@mcmaster.ca) 206 James Street South, Hamilton, Ont. L8P 3A9, Canada. CORRESPONDENCE ADDRESS A. Thoma, 206 James Street South, Hamilton, Ont. L8P 3A9, Canada. Email: athoma@mcmaster.ca SOURCE Plastic and Reconstructive Surgery (2004) 113:6 (1650-1661). Date of Publication: May 2004 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits for 2002. Hospital costs were obtained from St. Joseph's Healthcare, a university teaching hospital in Hamilton, Ontario, Canada. The utilities of clinically important health states related to breast reconstruction were obtained from 32 "experts" across Canada and converted into quality-adjusted life years. The probabilities of these various clinically important health states being associated with the DIEP and free TRAM flaps were obtained after a thorough review of the literature. The DIEP flap was more costly than the free TRAM flap ($7026.47 versus $6508.29), but it provided more quality-adjusted life years than the free TRAM flap (28.88 years versus 28.53 years). The baseline incremental cost-utility ratio was $1464.30 per quality-adjusted life year, favoring adoption of the DIEP flap. Sensitivity analyses were performed by assuming that the probabilities of occurrence of hernia, abdominal bulging, total flap loss, operating room time, and hospital stay were identical with the DIEP and free TRAM techniques. By assuming that the probability of postoperative hernia for the DIEP flap increased from 0.008 to 0.054 (same as for TRAM flap), the incremental cost-utility ratio changed to $1435.00 per quality-adjusted life year. A sensitivity analysis was performed for the complication of hernia because the DIEP flap allegedly diminishes this complication. Increasing the probability of abdominal bulge from 0.041 to 0.103 for the DIEP flap changed the ratio to $2731.78 per quality-adjusted life year. When the probability of total flap failure was increased from 0.014 to 0.016, the ratio changed to $1384.01 per quality-adjusted life year. When the time in the operating room was assumed to be the same for both flaps, the ratio changed to $4026.57 per quality-adjusted life year. If the hospital stay was assumed to be the same for both flaps, the ratio changed to $1944.30 per quality-adjusted life year. On the basis of the baseline calculation and sensitivity analyses, the DIEP flap remained a cost-effective procedure. Thus, adoption of this new technique for postmastectomy reconstruction is warranted in the Canadian health care system. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction deep inferior epigastric perforator flap free tissue graft free transverse rectus abdominis myocutaneous flap mastectomy EMTREE MEDICAL INDEX TERMS article Canada cost effectiveness analysis graft rejection health care cost health care system hernia (complication) human intermethod comparison model operation duration postoperative complication priority journal quality of life surgical technique treatment failure EMBASE CLASSIFICATIONS Surgery (9) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004388687 MEDLINE PMID 15114125 (http://www.ncbi.nlm.nih.gov/pubmed/15114125) PUI L39201794 DOI 10.1097/01.PRS.0000117196.61020.FD FULL TEXT LINK http://dx.doi.org/10.1097/01.PRS.0000117196.61020.FD COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 482 TITLE Shared decision making in primary breast cancer ORIGINAL (NON-ENGLISH) TITLE Partizipative entscheidungsfindung beim primären mammakarzinom AUTHOR NAMES Vodermaier A. Caspari C. Köhm J. Bauerfeind I. Kahlert S. Untch M. AUTHOR ADDRESSES (Vodermaier A., Andrea.Vodermaier@med.uni-muenchen.de; Caspari C.; Köhm J.; Bauerfeind I.; Kahlert S.; Untch M.) Ludwig-Maximilians-Univ. Munchen, Klin./Poliklin. Frauenk./G.-G., München, Germany. (Vodermaier A., Andrea.Vodermaier@med.uni-muenchen.de) Ludwig-Maximilians-Univ. Munchen, Klin./Poliklin. Frauenk./G.-G., Marchioninistr. 15, 81377 München, Germany. CORRESPONDENCE ADDRESS A. Vodermaier, Ludwig-Maximilians-Univ. Munchen, Klin./Poliklin. Frauenk./G.-G., Marchioninistr. 15, 81377 München, Germany. Email: Andrea.Vodermaier@med.uni-muenchen.de SOURCE Zeitschrift fur Arztliche Fortbildung und Qualitatssicherung (2004) 98:2 (127-133). Date of Publication: March 2004 ISSN 1431-7621 BOOK PUBLISHER Urban und Fischer Verlag Jena, P.O. Box 100537, Jena, Germany. ABSTRACT Following an overall view of the emotional situation of primary breast cancer patients and of studies exploring shared decision making in this setting we present the results of qualitative analyses about breaking bad news situations and interviews with this group of patients and describe both methods for implementing shared decision making in the treatment of primary breast cancer and an evaluation study. The main result was that most patients showed a lack of information about breast cancer and its therapy, which led to uncertainty. Another source of uncertainty was the lack of preoperative punch biopsy. Due to the so-called "diagnostic shock" patients felt under pressure to make a quick decision over their treatment. This perceived pressure can be effectively countered by a shared decision making approach. To investigate the options in breast cancer therapy, decision aids for diagnostic and therapeutic options have been developed focusing on the following treatment modalities: 1. breast conserving therapy and radiation versus radical mastectomy 2. chemotherapy plus endocrine therapy versus endocrine therapy alone 3. preoperative versus postoperative chemotherapy The decision instruments in question were tested in N = 35 breast cancer patients and N = 36 nurses as a control group. The results of a questionnaire survey among both these groups revealed a very positive appraisal of the decision aids. Implementation in daily routine was favoured. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, drug therapy, radiotherapy, surgery) decision making EMTREE MEDICAL INDEX TERMS algorithm cancer chemotherapy cancer radiotherapy conservative treatment doctor patient relation female human intermethod comparison interview mastectomy patient counseling physician attitude practice guideline process model punch biopsy qualitative analysis quality of life questionnaire review treatment planning CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2004182095 MEDLINE PMID 15106493 (http://www.ncbi.nlm.nih.gov/pubmed/15106493) PUI L38523537 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 483 TITLE Intraoperative frozen section of sentinel nodes: a formal decision analysis. AUTHOR NAMES Chao C. Abell T. Martin 2nd. R.C. McMasters K.M. AUTHOR ADDRESSES (Chao C.; Abell T.; Martin 2nd. R.C.; McMasters K.M.) Department of Surgery, University of Texas Medical Branch, Galveston 77555-0527, USA. CORRESPONDENCE ADDRESS C. Chao, Department of Surgery, University of Texas Medical Branch, Galveston 77555-0527, USA. SOURCE The American surgeon (2004) 70:3 (215-220; discussion 220-221). Date of Publication: Mar 2004 ISSN 0003-1348 ABSTRACT In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) frozen section lymph node quality of life sentinel lymph node biopsy EMTREE MEDICAL INDEX TERMS adult aged article cancer staging comparative study decision support system disease free survival epidemiology female human immunohistochemistry mastectomy methodology middle aged mortality needle biopsy pathology peroperative care probability prognosis retrospective study risk assessment sensitivity and specificity survival treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 15055844 (http://www.ncbi.nlm.nih.gov/pubmed/15055844) PUI L38487159 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 484 TITLE Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation AUTHOR NAMES Van Roosmalen M.S. Stalmeier P.F.M. Verhoef L.C.G. Hoekstra-Weebers J.E.H.M. Oosterwijk J.C. Hoogerbrugge N. Moog U. Van Daal W.A.J. AUTHOR ADDRESSES (Van Roosmalen M.S., m.vanroosmalen@rther.umcn.nl; Stalmeier P.F.M.; Verhoef L.C.G.; Van Daal W.A.J.) Jt. Ctr. Radiat. Oncol. Arnhem-N., University Medical Center Nijmegen, Nijmegen, Netherlands. (Stalmeier P.F.M.) Medical Technology Assessment, University Medical Center Nijmegen, Nijmegen, Netherlands. (Hoekstra-Weebers J.E.H.M.) Department of Medical Psychology, University Hospital Groningen, Groningen, Netherlands. (Oosterwijk J.C.) Department of Medical Genetics, University Hospital Groningen, Groningen, Netherlands. (Hoogerbrugge N.) Department of Human Genetics, Hereditary Cancer Clinic, University Medical Center Nijmegen, Nijmegen, Netherlands. (Moog U.) Department of Clinical Genetics, University Hospital Maastricht, Maastricht, Netherlands. CORRESPONDENCE ADDRESS M.S. Van Roosmalen, Jt. Ctr. Radiat. Oncol. Arnhem-N., University Medical Center Nijmegen, Nijmegen, Netherlands. Email: m.vanroosmalen@rther.umcn.nl SOURCE British Journal of Cancer (2004) 90:2 (333-342). Date of Publication: 26 Jan 2004 ISSN 0007-0920 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT The aim of the study was to evaluate the impact of a decision aid (DA) and its timing in women being tested for a BRCA1/2 mutation. Women with and without a previous history of cancer were included after blood sampling for genetic testing. The DA consisted of a brochure and video providing information on screening and prophylactic surgery. To evaluate the impact of the DA, women were randomised to the DA group (n = 184), receiving the DA 2 weeks after blood sampling, or to the control group (n = 184). To evaluate the impact of timing, mutation carriers who had received the DA before the test result (n = 47) were compared to mutation carriers who received the DA after the test result (n = 42). Data were collected on well-being, treatment choice, decision and information related outcomes. The impact of the DA was measured 4 weeks after blood sampling. The impact of timing was measured 2 weeks after a positive test result. The DA had no impact on well-being. Regarding decision related outcomes, the DA group more frequently considered prophylactic surgery (P = 0.02) corroborated with higher valuations (P = 0.04). No differences were found for the other decision related outcomes. Regarding information related outcomes, the DA group felt better informed (P = 0.00), was more satisfied with the information (P = 0.00), and showed more accurate risk perceptions. Timing of the DA had no effect on any of the outcomes. No interactions were found between the DA and history of cancer. In conclusion, women being tested for a BRCA1/2 mutation benefit from the DA on information related outcomes. Because timing had no effect the DA is considered useful either before or after the test result. © 2004 Cancer Research UK. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS adult article cancer screening controlled study decision making female gene mutation genetic analysis genetic counseling human major clinical study mastectomy patient satisfaction priority journal psychological aspect treatment planning wellbeing EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004093205 MEDLINE PMID 14735173 (http://www.ncbi.nlm.nih.gov/pubmed/14735173) PUI L38250625 DOI 10.1038/sj.bjc.6601525 FULL TEXT LINK http://dx.doi.org/10.1038/sj.bjc.6601525 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 485 TITLE Applying the neoadjuvant paradigm to ductal carcinoma in situ. AUTHOR NAMES Esserman L. Sepucha K. Ozanne E. Hwang E.S. AUTHOR ADDRESSES (Esserman L.; Sepucha K.; Ozanne E.; Hwang E.S.) Department of Surgery, University of California San Francisco Medical Center, San Francisco, California 94115, USA. CORRESPONDENCE ADDRESS L. Esserman, Department of Surgery, University of California San Francisco Medical Center, San Francisco, California 94115, USA. Email: laura.esserman@ucsfmedctr.org SOURCE Annals of surgical oncology : the official journal of the Society of Surgical Oncology (2004) 11:1 Suppl (28S-36S). Date of Publication: Jan 2004 ISSN 1068-9265 ABSTRACT Local treatment options for ductal carcinoma in situ (DCIS) are virtually identical to those for early invasive breast cancer, despite the fact that the survival from this condition is much higher. Our ability to more appropriately tailor therapy for DCIS is hampered by a lack of understanding of the natural history of DCIS, our limited ability to predict the rate of progression to invasive cancer and the response to therapy, and the absence of tools to follow patients who have not had invasive treatments. Neoadjuvant therapy, which has been proven to be both safe and effective in tailoring treatments for invasive cancer, could be ideally suited to DCIS. However, neoadjuvant therapy requires that doctors and patients delay surgical treatment that has known benefits. In order to successfully introduce this approach into clinical practice, risk assessment and decision support tools will be needed to help physicians and patients feel comfortable that they are not being exposed to unnecessary or excessive risk. In addition, we need better imaging to track extent and progression of disease. Among the possible benefits of the neoadjuvant approach, we may discover that many lesions are responsive and some even reversible, leaving us with treatments that might be tailored to biology and with important clues for breast cancer prevention in high-risk women. EMTREE DRUG INDEX TERMS prostaglandin synthase inhibitor (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast tumor (epidemiology, therapy) Paget nipple disease (epidemiology, therapy) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article decision support system disease course female human nuclear magnetic resonance imaging partial mastectomy risk assessment sensitivity and specificity LANGUAGE OF ARTICLE English MEDLINE PMID 15015707 (http://www.ncbi.nlm.nih.gov/pubmed/15015707) PUI L38548346 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 486 TITLE Cost-utility analysis comparing free and pedicled TRAM flap for breast reconstruction AUTHOR NAMES Thoma A. Khuthaila D. Rockwell G. Veltri K. AUTHOR ADDRESSES (Thoma A., athoma@mcmaster.ca) Div. of Plast. and Reconstr. Surgery, Department of Surgery, McMaster University, Hamilton, Ont., Canada. (Khuthaila D.) Plastic Surgery Program, McMaster University, Hamilton, Ont., Canada. (Rockwell G.) Division of Plastic Surgery, McMaster University, Hamilton, Ont., Canada. (Veltri K.) Medical Sciences Program, McMaster University, Hamilton, Ont., Canada. (Thoma A., athoma@mcmaster.ca) 206 James St. South, Hamilton, Ont. L8P 3A9, Canada. CORRESPONDENCE ADDRESS A. Thoma, 206 James St. South, Hamilton, Ont. L8P 3A9, Canada. Email: athoma@mcmaster.ca SOURCE Microsurgery (2003) 23:4 (287-295). Date of Publication: 2003 ISSN 0738-1085 BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT The purpose of this study was to compare the free TRAM to the unipedicled TRAM flap in postmastectomy reconstruction, using a cost-utility analysis. A decision analytic model was used for this study. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits (1998). Hospital costs were obtained from St. Joseph's Healthcare, a university hospital in Hamilton, Ontario. Utilities were obtained from 33 "experts" across Canada and then converted into quality-adjusted life-years (QALYs). The probabilities of various health states associated with unipedicled and free TRAM flaps were obtained by reviewing several key articles. The free TRAM flap was more costly than the unipedicled TRAM flap, but it provided more QALYs. The baseline incremental cost-utility ratio (ICUR) was $5,113.73/QALY, favoring adoption of the free TRAM flap. This study showed that the free TRAM flap is a cost-effective procedure for postmastectomy reconstruction in the Canadian healthcare system. © 2003 Wiley-Liss, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS article cost utility analysis free tissue graft hospital cost medical decision making pedicled skin flap priority journal quality adjusted life year EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003366559 MEDLINE PMID 12942517 (http://www.ncbi.nlm.nih.gov/pubmed/12942517) PUI L37093594 DOI 10.1002/micr.10138 FULL TEXT LINK http://dx.doi.org/10.1002/micr.10138 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 487 TITLE Helping patients make informed choices: A randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer AUTHOR NAMES Whelan T. Sawka C. Levine M. Gafni A. Reyno L. Willan A. Julian J. Dent S. Abu-Zahra H. Chouinard E. Tozer R. Pritchard K. Bodendorfer I. AUTHOR ADDRESSES (Whelan T., tim.whelan@hrcc.on.ca; Levine M.) Cancer Care Ontario (CCO), Hamilton Regional Cancer Centre, McMaster University, 699 Concession St., Hamilton, Ont. L8V 5C2, Canada. (Sawka C.; Pritchard K.) CCO, Toronto Sunnybrook Reg. Cancer Ctr., Toronto, Ont., Canada. (Gafni A.; Willan A.; Julian J.; Bodendorfer I.) Supportive Cancer Care Research Unit, McMaster University, Cancer Care Ontario (CCO), 699 Concession St., Hamilton, Ont. L8V 5C2, Canada. (Reyno L.; Chouinard E.; Tozer R.) CCO, Hamilton Regional Cancer Centre, 699 Concession St., Hamilton, Ont. L8V 5C2, Canada. (Dent S.) CCO, Northwestern Ontario Reg. Cancer Ctr, Thunder Bay, Ont., Canada. (Abu-Zahra H.) CCO, Windsor Regional Cancer Centre, Windsor, Ont., Canada. CORRESPONDENCE ADDRESS T. Whelan, Supportive Cancer Care Research Unit, Hamilton Regional Cancer Centre, Cancer Care Ontario (CCO), 699 Concession St., Hamilton, Ont. L8V 5C2, Canada. Email: tim.whelan@hrcc.on.ca SOURCE Journal of the National Cancer Institute (2003) 95:8 (581-587). Date of Publication: 16 Apr 2003 ISSN 0027-8874 BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Background: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the "Decision Board" to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy. We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone. Methods: Between October 1995 and March 2000, 176 women with lymph nodenegative breast cancer who were candidates for adjuvant chemotherapy were randomly assigned to receive the Decision Board plus the medical consultation (83 patients) or the medical consultation alone (93 patients). One week after the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and chemotherapy. Satisfaction with decision making was assessed 1 week and 3, 6, and 12 months after randomization, and differences between groups were analyzed by a repeated measures analysis of variance. All statistical tests were two-sided. Results: Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm (mean knowledge score = 80.2 [on a scale of 0-100], 95% confidence interval [CI] = 77.1 to 83.3, and 71.7, 95% CI = 69.0 to 74.4, respectively; P<.001). Over the entire study period, satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm (P = .032). There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy (77% and 70% for patients in the Decision Board arm and those in the control arm, respectively; P = .303). Conclusion: When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS adult aged analysis of variance article axillary lymph node cancer adjuvant therapy cancer patient clinical trial consultation controlled clinical trial controlled study decision support system female general practitioner human informed consent intermethod comparison lymph node dissection lymph node metastasis (complication, prevention, surgery) major clinical study mastectomy medical assessment medical decision making medical information outcomes research partial mastectomy patient care patient education patient satisfaction priority journal questionnaire randomized controlled trial risk benefit analysis scoring system statistical analysis CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003189898 MEDLINE PMID 12697850 (http://www.ncbi.nlm.nih.gov/pubmed/12697850) PUI L36553504 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 488 TITLE Development of an interactive decision aid for female BRCA1/BRCA2 carriers AUTHOR NAMES Kaufman E.M. Peshkin B.N. Lawrence W.F. Shelby R. Isaacs C. Brown K. Rispoli J. O'Neill S. Hurley K. DeMarco T. Brogan B. Grumet S. Jandorf L. McKenna K. Valdimarsdottir H. Schwartz M.D. AUTHOR ADDRESSES (Kaufman E.M., emk6@georgetown.edu; Peshkin B.N.; Lawrence W.F.; Shelby R.; Isaacs C.; O'Neill S.; DeMarco T.; Brogan B.; McKenna K.; Schwartz M.D.) Department of Oncology, Georgetown University, Lombardi Cancer Center, Washington, DC, United States. (Brown K.; Rispoli J.) Department of Human Genetics, Mount Sinai School of Medicine, New York, NY, United States. (Hurley K.; Jandorf L.; Valdimarsdottir H.) Mount Sinai School of Medicine, Ruttenberg Cancer Center, New York, NY, United States. (Grumet S.) Englewood-Mt. Sinai Cancer Risk A., Englewood Hospital, Englewood, NJ, United States. (Kaufman E.M., emk6@georgetown.edu) Department of Oncology, Georgetown University, Lombardi Cancer Center, 2233 Wisconsin Avenue, NW, Washington, DC 20007, United States. CORRESPONDENCE ADDRESS E.M. Kaufman, Department of Oncology, Georgetown University, Lombardi Cancer Center, 2233 Wisconsin Avenue, NW, Washington, DC 20007, United States. Email: emk6@georgetown.edu SOURCE Journal of Genetic Counseling (2003) 12:2 (109-129). Date of Publication: Apr 2003 ISSN 1059-7700 ABSTRACT Shared decision making between patients and providers is becoming increasingly common, particularly when there is no clear preferred course of action. As a result, decision aids are being adopted with growing frequency and have been applied to many medical decision-making issues. One such issue where there is uncertainty is breast cancer risk management among BRCA1/BRCA2 carriers. We present the development of a CD-ROM decision aid to facilitate risk management decision making in this population. Our decision aid was developed with the intention of providing it through a randomized clinical trial. The CD-ROM is a multimedia, interactive intervention which provides information about breast cancer, risks associated with BRCA1 and BRCA2 mutations, risk management options for hereditary breast cancer, and a breast cancer risk management decision aid. The goal of this CD-ROM, offered as an adjunctive intervention, is to reduce decisional conflict and psychological distress and improve comprehension of risk information, decisional satisfaction, medical adherence, and quality of life for this population of women at increased risk for breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (prevention, surgery, therapy) decision support system genetic counseling heterozygote oncogene EMTREE MEDICAL INDEX TERMS cancer risk cancer screening cancer surgery cancer therapy chemoprophylaxis computer aided design conflict distress syndrome family counseling gene mutation genetic risk human medical decision making mutational analysis ovary carcinoma patient compliance population research population risk process development quality of life review risk assessment risk reduction satisfaction software treatment indication EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004331714 PUI L39012936 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 489 TITLE Decision-making for patients with resectable breast cancer: individualized decisions for and by patients and their physicians. AUTHOR NAMES Loprinzi C.L. Ravdin P.M. AUTHOR ADDRESSES (Loprinzi C.L.; Ravdin P.M.) Mayo Clinic, Rochester, Minnesota 550905, USA. CORRESPONDENCE ADDRESS C.L. Loprinzi, Mayo Clinic, Rochester, Minnesota 550905, USA. Email: cloprinzi@mayo.edu SOURCE Journal of the National Comprehensive Cancer Network : JNCCN (2003) 1:2 (189-196). Date of Publication: Apr 2003 ISSN 1540-1405 ABSTRACT Decisions regarding the use of adjuvant cytotoxic and hormonal therapies for women with breast cancer ideally should be made jointly by the patient and oncologist. For patients to be adequately involved in this decision-making process, they must be provided with appropriate education regarding the potential benefits and risks of adjuvant therapies. The recommended steps for doing this are: 1) understand baseline prognosis with locoregional therapy (surgery, radiation, or both) alone for the individual patient at hand; 2) determine the estimated benefit afforded by adjuvant therapy options for the individual patient; 3) estimate the risk of side effects of adjuvant therapy options; 4) convey the above information to the individual patient; 5) facilitate the individual patient's decision regarding adjuvant systemic therapy; and 6) support the patient's decision. Two computer-based tools (Numeracy and Adjuvant!) are available to facilitate this process. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) antineoplastic hormone agonists and antagonists EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy) decision support system EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy female human patient attitude practice guideline review LANGUAGE OF ARTICLE English MEDLINE PMID 19768877 (http://www.ncbi.nlm.nih.gov/pubmed/19768877) PUI L355568023 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 490 TITLE The benefits and costs of tamoxifen for breast cancer prevention AUTHOR NAMES Eckermann S.D. Martin A.J. Stockler M.R. Simes R.J. AUTHOR ADDRESSES (Eckermann S.D., simon@ctc.usyd.edu.au; Martin A.J.; Simes R.J.) NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia. (Martin A.J.) Roche Products Pty Ltd., Dee Why, NSW, Australia. (Stockler M.R.) NHMRC Clinical Trials Centre, Department of Medicine, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia. (Stockler M.R.) Royal Prince Alfred Hospital, Camperdown, NSW, Australia. CORRESPONDENCE ADDRESS S.D. Eckermann, NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia. Email: simon@ctc.usyd.edu.au SOURCE Australian and New Zealand Journal of Public Health (2003) 27:1 (34-40). Date of Publication: 2003 ISSN 1326-0200 BOOK PUBLISHER Public Health Association of Australia Inc., PO Box 319, Curtin, Australia. ABSTRACT Objective: To estimate the effects of key uncertainties on the effectiveness and cost-effectiveness of breast cancer prevention with tamoxifen. Methods: The incremental cost-effectiveness ratio of tamoxifen therapy relative to placebo was estimated using decision analysis with Markov modelling of health states, outcomes and costs for a simulated cohort of women at high risk for breast cancer. Relative effects of tamoxifen's benefits and harms were estimated from meta-analyses of randomised controlled trials. Cost estimates were based on Australian treatment patterns and costs. The main outcome measure was cost per quality-adjusted life year (QALY) gained with costs and effects discounted at a 5% annual rate. Results: Tamoxifen therapy over five years reduces the incidence of breast cancer by approximately 1.4%, which is offset by an increase in endometrial cancer of 0.7% and pulmonary embolism of 0.2%. If the reduction is permanent (preventing new breast cancers emerging over five years and no further treatment effect thereafter), the model estimates an increase in life expectancy of 0.057 QALYs and an extra cost of $2,193; or $38,271/QALY gained. A model assuming further treatment effects of tamoxifen preventing new breast cancers emerging for up to 10 years results in an incremental cost of $19,354/QALY. However, if five years of tamoxifen therapy merely delays when these breast cancers appear (such that by 10 years there is no longer a reduced incidence), the incremental cost per QALY saved is estimated to be $199,149. Conclusions: Tamoxifen is potentially cost-effective in preventing breast cancer in women at high risk. However, its cost-effectiveness as a preventive therapy is highly sensitive to whether these cancers are permanently prevented or their clinical presentation is only delayed. Long-term follow-up in randomised controlled trials is therefore crucial in forming health policy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tamoxifen (adverse drug reaction, clinical trial, drug therapy, pharmacoeconomics, pharmacology) EMTREE DRUG INDEX TERMS placebo EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, drug therapy, epidemiology, prevention, radiotherapy, surgery) cost benefit analysis cost effectiveness analysis EMTREE MEDICAL INDEX TERMS article Australia cancer chemotherapy cancer incidence cancer mortality cancer prevention cancer radiotherapy cancer risk cataract (side effect) clinical trial cohort analysis controlled clinical trial controlled study drug cost drug efficacy endometrium cancer (side effect) female follow up gynecologic disease (side effect) health status high risk patient human life expectancy long term care lung embolism (side effect) major clinical study mastectomy medical decision making meta analysis Monte Carlo method outcomes research quality adjusted life year randomized controlled trial statistical model vasomotor disorder (side effect) CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Radiology (14) Clinical and Experimental Pharmacology (30) Surgery (9) Health Policy, Economics and Management (36) Cancer (16) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003091229 MEDLINE PMID 14705265 (http://www.ncbi.nlm.nih.gov/pubmed/14705265) PUI L36253716 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 491 TITLE Preventive mastectomy in patients at breast cancer risk due to genetic alterations in the BRCA1 and BRCA2 gene AUTHOR NAMES Taucher S. Gnant M. Jakesz R. AUTHOR ADDRESSES (Taucher S., susanne.taucher@univie.ac.at; Gnant M.; Jakesz R.) Department of Surgery, Medical School, Vienna University, Waehringer Guertel 18-20, 1090 Vienna, Austria. CORRESPONDENCE ADDRESS S. Taucher, Department of Surgery, Medical School, Vienna University, Waehringer Guertel 18-20, 1090 Vienna, Austria. Email: susanne.taucher@univie.ac.at SOURCE Langenbeck's Archives of Surgery (2003) 388:1 (3-8). Date of Publication: March 2003 ISSN 1435-2443 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Background: The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 gene provides potentially valuable information to women at high risk of breast and ovarian cancer. Methods andfocus: We review the literature on the value of prophylactic surgical strategies in patients with hereditary predisposition to develop breast cancer and discuss the surgical options available in high-risk cancer patients, decision analyses, and possible complications. Results: Preventive surgical interventions to reduce cancer risk in high-risk patients are often strongly recommended. A patient's life-time risk to develop breast cancer in the presence of BRCA1 and BRCA2 mutations is 50-90%. Despite the reduction in the risk of developing breast cancer, prophylactic mastectomy often leads to significant physical and psychological sequelae. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) gene mutation mastectomy EMTREE MEDICAL INDEX TERMS cancer risk cancer susceptibility genetic analysis genetic predisposition high risk patient human inheritance oncogene ovary cancer priority journal review EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003365640 MEDLINE PMID 12690474 (http://www.ncbi.nlm.nih.gov/pubmed/12690474) PUI L37092459 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 492 TITLE Morphometrical malignancy grading is a valuable prognostic factor in invasive ductal breast cancer AUTHOR NAMES Kronqvist P. Kuopio T. Jalava P. Collan Y. AUTHOR ADDRESSES (Kronqvist P., pauliina.kronqvist@tyks.fi; Jalava P.; Collan Y.) Department of Pathology, University of Turku, Kiinamyllynkatu 10 FIN-20520 Turku, Finland. (Kuopio T.) Department of Pathology, Jyväskylä Central Hospital, Jyväskylä, Finland. CORRESPONDENCE ADDRESS P. Kronqvist, Department of Pathology, University of Turku, Kiinamyllynkatu 10 FIN-20520 Turku, Finland. Email: pauliina.kronqvist@tyks.fi SOURCE British Journal of Cancer (2002) 87:11 (1275-1280). Date of Publication: 18 Nov 2002 ISSN 0007-0920 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT The aim of the present study is to augment the prognostic power of breast cancer grading by elaboration of quantitative histopathological methods. We focus on the recently introduced morphometrical grading system in which the three grading sub-features of the WHO grading system are evaluated with the help of computerised nuclear morphometry, and quantitative methods for assessing mitotic activity and tubular differentiation. The prognostic value of the morphometrical grading system is now confirmed in a material of 159 cases of invasive ductal breast cancer. In the current material the morphometrical grading system very efficiently predicted the prognosis of breast cancer by dividing the patients into favourable (grade I), intermediate (grade II), and unfavourable (grade III) outcome (P < 0.0001). The morphometrical grading system was especially efficient in identifying patients with the most unfavourable outcome. In our material the morphometrical grade III was associated with a 5.4-fold risk of breast cancer death. In light of the present results, the morphometrical grading can be applied to clinical use as an aid in treatment decisions of patients with invasive ductal breast cancer. © 2002 Cancer Research UK. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer grading morphometry prognosis EMTREE MEDICAL INDEX TERMS adult aged article cancer mortality cell differentiation female histopathology human major clinical study medical decision making mitosis rate priority journal quantitative analysis EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003003641 MEDLINE PMID 12439717 (http://www.ncbi.nlm.nih.gov/pubmed/12439717) PUI L36009133 DOI 10.1038/sj.bjc.6600617 FULL TEXT LINK http://dx.doi.org/10.1038/sj.bjc.6600617 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 493 TITLE Stochastic trees and the StoTree modeling environment: Models and software for medical decision analysis AUTHOR NAMES Hazen G.B. AUTHOR ADDRESSES (Hazen G.B.) IE/MS Department, Northwestern University, Evanston, IL 60208, United States. CORRESPONDENCE ADDRESS G.B. Hazen, IE/MS Department, Northwestern University, Evanston, IL 60208, United States. SOURCE Journal of Medical Systems (2002) 26:5 (399-413). Date of Publication: October 2002 ISSN 0148-5598 BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT In this paper we present a review of stochastic trees, a convenient modeling approach for medical treatment decision analyses. Stochastic trees are a generalization of decision trees that incorporate useful features from continuous-time Markov chains. We also discuss StoTree, a freely available software tool for the formulation and solution of stochastic trees, implemented in the Excel spreadsheet environment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical decision making medical information system stochastic model EMTREE MEDICAL INDEX TERMS breast cancer (diagnosis, radiotherapy, surgery) cancer radiotherapy cause of death cerebrovascular accident decision theory human immunosuppressive treatment kidney graft rejection (complication, prevention) kidney transplantation mammography mastectomy mathematical model melanoma partial mastectomy probability review software treatment indication treatment planning EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Urology and Nephrology (28) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004148621 MEDLINE PMID 12182205 (http://www.ncbi.nlm.nih.gov/pubmed/12182205) PUI L38420745 DOI 10.1023/A:1016401115823 FULL TEXT LINK http://dx.doi.org/10.1023/A:1016401115823 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 494 TITLE Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations: An updated decision analysis AUTHOR NAMES Grann V.R. Jacobson J.S. Thomason D. Hershman D. Heitjan D.F. Neugut A.I. AUTHOR ADDRESSES (Grann V.R.; Jacobson J.S.; Thomason D.; Hershman D.; Heitjan D.F.; Neugut A.I.) Herbert Irving Compreh. Cancer Ctr., Columbia University, 630 W 168th St, New York, NY 10032, United States. CORRESPONDENCE ADDRESS V.R. Grann, Herbert Irving Compreh. Cancer Ctr., Columbia University, 630 W 168th St, New York, NY 10032, United States. Email: VRG2@columbia.edu SOURCE Journal of Clinical Oncology (2002) 20:10 (2520-2529). Date of Publication: 15 May 2002 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: This study updates findings regarding the effects of prophylactic surgery, chemoprevention, and surveillance on the survival and quality-adjusted survival of women who test positive for BRCA1/2 mutations. Materials and Methods: Markov modeling of outcomes was performed in a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations. The model incorporated breast and ovarian cancer incidence rates from the literature and mortality rates from the Surveillance, Epidemiology, and End Results Program. Quality adjustment of survival estimates were obtained from a survey of women aged 33 to 50 years. Sensitivity analyses were performed of varied assumptions regarding timing and effects of preventive measures on cancer incidence and adverse effects. Results: A 30-year-old woman could prolong her survival beyond that associated with surveillance alone by use of preventive measures: 1.8 years with tamoxifen, 2.6 years with prophylactic oophorectomy, 4.6 years with both tamoxifen and prophylactic oophorectomy, 3.5 years with prophylactic mastectomy, and 4.9 years with both surgeries. She could prolong her quality-adjusted survival by 2.8 years with tamoxifen, 4.4 years with prophylactic oophorectomy, 6.3 years with tamoxifen and oophorectomy, and 2.6 years with mastectomy, or with both surgeries. The benefits of all of these strategies would decrease if they were initiated at later ages. Conclusion: Women who test positive for BRCA1/2 mutations may derive greater survival and quality adjusted survival benefits than previously reported from chemoprevention, prophylactic surgery, or a combination. Observational studies and clinical trials are needed to verify the results of this analysis of the long-term benefits of preventive strategies among BRCA1/2-positive women. © 2002 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE DRUG INDEX TERMS tamoxifen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer prevention cancer survival gene mutation oncogene EMTREE MEDICAL INDEX TERMS adult article cancer mortality chemoprophylaxis female human mastectomy ovariectomy priority journal probability CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002179870 MEDLINE PMID 12011131 (http://www.ncbi.nlm.nih.gov/pubmed/12011131) PUI L34525739 DOI 10.1200/JCO.2002.10.101 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2002.10.101 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 495 TITLE Immediate versus delayed free TRAM breast reconstructions: An analysis of perioperative factors and complications AUTHOR NAMES Bulstrode N.W. Wilson G.R. Inglis M.S. AUTHOR ADDRESSES (Bulstrode N.W.; Wilson G.R.) Department of Plastic Surgery, Chelsea and Westminster Hospital, Fulham Road, London, Chelsea SW10 9NH, United Kingdom. (Inglis M.S.) Ashstead Hospital, Ashstead, Surrey, United Kingdom. CORRESPONDENCE ADDRESS Department of Plastic Surgery, Chelsea and Westminster Hospital, Fulham Road, London, Chelsea SW10 9NH, United Kingdom. SOURCE British Journal of Plastic Surgery (2002) 55:2 (111-116). Date of Publication: 2002 ISSN 0007-1226 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Immediate breast reconstruction provides superior psychological benefit to the patient compared with delayed reconstruction, and has a financial advantage. Smokers undergoing immediate free TRAM breast reconstruction have a higher incidence of flap necrosis than smokers undergoing delayed free TRAM reconstruction. Whereas the differences in psychological benefit, effects of smoking and cost are well addressed in the literature, the differences in morbidity between immediate and delayed free TRAM breast reconstruction are still unknown. Knowledge of any differences would help to determine the best timing for reconstruction, and would support surgical decision making and preoperative patient advice. We present a retrospective review of 105 consecutive free TRAM breast reconstructions performed in 97 patients (89 unilateral and eight bilateral reconstructions). There were 48 immediate reconstructions and 57 delayed reconstructions. In the immediate-reconstruction group six flaps required revision of the anastomosis, and three flaps (6%) were lost. In the delayed-reconstruction group five flaps required revision of the anastomosis, and only one flap (2%) could not be salvaged. Delayed healing of the chest-wall skin flaps only occurred in immediate reconstructions (16%, P = 0.017). © 2002 The British Association of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adult anastomosis article controlled study cost benefit analysis fat necrosis (complication) female hematoma (complication) human intermethod comparison major clinical study medical decision making morbidity perioperative period postoperative complication (complication) preoperative period priority journal psychology reoperation retrospective study skin flap smoking surgical technique time tissue necrosis (complication) wound healing EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002151138 MEDLINE PMID 11987942 (http://www.ncbi.nlm.nih.gov/pubmed/11987942) PUI L34436582 DOI 10.1054/bjps.2002.3747 FULL TEXT LINK http://dx.doi.org/10.1054/bjps.2002.3747 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 496 TITLE Decision analysis of prophylactic surgery or screening for BRCA1 mutation carriers: A more prominent role for oophorectomy AUTHOR NAMES Van Roosmalen M.S. Verhoef L.C.G. Stalmeier P.F.M. Hoogerbrugge N. Van Daal W.A.J. AUTHOR ADDRESSES (Van Roosmalen M.S.; Verhoef L.C.G.; Stalmeier P.F.M.; Hoogerbrugge N.; Van Daal W.A.J.) RADIAN, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. CORRESPONDENCE ADDRESS M.S. Van Roosmalen, RADIAN, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. Email: m.vanroosmalen@rther.azn.nl SOURCE Journal of Clinical Oncology (2002) 20:8 (2092-2100). Date of Publication: 15 Apr 2002 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: BRCA1 mutation carriers have a high risk of developing breast and ovarian cancer. Carriers may opt for prophylactic surgery and screening. Recent data suggesting that prophylactic oophorectomy reduces breast cancer risk have been incorporated in a decision analysis. Methods: A Markov model was developed to compare LE and QALE following four strategies: (1) prophylactic mastectomy and prophylactic oophorectomy (PMPO), (2) screening for breast cancer and prophylactic oophorectomy (BSPO), (3) prophylactic mastectomy and screening for ovarian cancer (PMOS), and (4) screening for breast and ovarian cancer (BSOS). The analysis was performed for a high (85% breast cancer, 63% ovarian cancer) and medium (56% breast cancer, 16% ovarian cancer) risk level. Utilities for the health states after prophylactic surgery were obtained from mutation carriers. Other model parameter values were obtained from the literature. Sensitivity analyses were performed. Results: When compared with BSOS, the average gain in LE for 30-year-old carriers in the high (medium) risk group was 11.7 (6.6) years for PMPO, 9.5 (5.3) years for BSPO, and 4.9 (4.4) years for PMOS. For 30-year-old carriers, BSPO had a QALE advantage when PO was performed before age 40. In the medium-risk group, there was a stronger advantage for BSPO when QALE was considered. Conclusion: PMPO is the most effective strategy to prolong life. However, if patient preferences were taken into account, BSPO tends to be a better strategy in most women at medium risk or in young women at high risk when PO was performed before age 40. © 2002 by American Society of Clinical Oncology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, prevention, surgery) gene mutation ovariectomy ovary cancer (diagnosis, prevention, surgery) EMTREE MEDICAL INDEX TERMS adult age article cancer prevention cancer risk cancer screening cancer surgery decision making female genetic screening heterozygote human mastectomy oncogene priority journal statistical analysis EMBASE CLASSIFICATIONS Surgery (9) Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002146598 MEDLINE PMID 11956270 (http://www.ncbi.nlm.nih.gov/pubmed/11956270) PUI L34408800 DOI 10.1200/JCO.2002.08.035 FULL TEXT LINK http://dx.doi.org/10.1200/JCO.2002.08.035 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 497 TITLE Benefits, harms and costs of screening mammography in women 70 years and over: A systematic review AUTHOR NAMES Barratt A.L. Irwig L.M. Glasziou P.P. Salkeld G.P. Houssami N. AUTHOR ADDRESSES (Barratt A.L.; Irwig L.M.; Glasziou P.P.; Salkeld G.P.; Houssami N.) Dept. of Pub. Hlth./Community Med., Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia. CORRESPONDENCE ADDRESS A.L. Barratt, Dept. of Pub. Hlth./Community Med., Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia. Email: alexb@health.usyd.edu.au SOURCE Medical Journal of Australia (2002) 176:6 (266-271). Date of Publication: 18 Mar 2002 ISSN 0025-729X BOOK PUBLISHER Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road, Pyrmont, Australia. ABSTRACT Objective: To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. Data sources and synthesis: (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. Results: For women aged 70-79 years, the relative benefit was estimated as 40% - 72%, and 18% - 62% with adjustment for the impact of screening on quality of life. For women over 80 years the relative benefit was about a third, and with quality-of-life adjustment only 14%, that in women aged 50-69 years. (ii) Of 10 000 Australian women participating in ongoing screening, about 400 are recalled for further testing, and, depending on age, about 70-112 undergo biopsy and about 19-80 cancers are detected. (iii) Cost-effectiveness estimates for extending the upper age limit for mammographic screening from 69 to 79 years range from $8119 to $27 751 per quality-adjusted life-year saved, which compares favourably with extending screening to women aged 40-49 years (estimated at between $24 000 and $65 000 per life-year saved). Conclusions: Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (diagnosis, disease management, epidemiology, surgery) mammography screening test EMTREE MEDICAL INDEX TERMS aged Australia breast biopsy breast cancer (diagnosis, disease management, epidemiology, surgery) cancer risk cancer screening consultation cost benefit analysis cost effectiveness analysis decision making elderly care female health care utilization human life expectancy mastectomy population research quality adjusted life year quality of life review sensitivity and specificity standardization statistical model validation process EMBASE CLASSIFICATIONS Cancer (16) Radiology (14) Health Policy, Economics and Management (36) Biophysics, Bioengineering and Medical Instrumentation (27) Gerontology and Geriatrics (20) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002108080 MEDLINE PMID 11999259 (http://www.ncbi.nlm.nih.gov/pubmed/11999259) PUI L34240067 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 498 TITLE National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1-3, 2000. AUTHOR ADDRESSES SOURCE Journal of the National Cancer Institute. Monographs (2001) :30 (5-15). Date of Publication: 2001 ISSN 1052-6773 ABSTRACT OBJECTIVE: Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. PARTICIPANTS: The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. EVIDENCE: The literature was searched with the use of MEDLINE for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://consensus.nih.gov. CONCLUSIONS: The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) EMTREE MEDICAL INDEX TERMS clinical trial conference paper consensus development controlled clinical trial human multimodality cancer therapy practice guideline quality of life randomized controlled trial LANGUAGE OF ARTICLE English MEDLINE PMID 11773285 (http://www.ncbi.nlm.nih.gov/pubmed/11773285) PUI L35564676 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 499 TITLE Potential of computer-aided diagnosis to reduce variability in radiologists' interpretations of mammograms depicting microcalcifications AUTHOR NAMES Jiang Y. Nishikawa R.M. Schmidt R.A. Toledano A.Y. Doi K. AUTHOR ADDRESSES (Jiang Y.; Nishikawa R.M.; Schmidt R.A.; Toledano A.Y.; Doi K.) Dept of Radiology, Univ of Chicago, MC2026, 5841 S Maryland Ave, Chicago, IL 60637, United States. CORRESPONDENCE ADDRESS Y. Jiang, Dept of Radiology, Univ of Chicago, MC2026, 5841 S Maryland Ave, Chicago, IL 60637, United States. Email: y-jiang@uchicago.edu SOURCE Radiology (2001) 220:3 (787-794). Date of Publication: 2001 ISSN 0033-8419 BOOK PUBLISHER Radiological Society of North America Inc., 820 Jorie Boulevard, Oak Brook, United States. ABSTRACT PURPOSE: To evaluate whether computer-aided diagnosis can reduce interobserver variability in the interpretation of mammograms. MATERIALS AND METHODS: Ten radiologists interpreted mammograms showing clustered microcalcifications in 104 patients. Decisions for biopsy or follow-up were made with and without a computer aid, and these decisions were compared. The computer was used to estimate the likelihood that a microcalcification cluster was due to a malignancy. Variability in the radiologists' recommendations for biopsy versus follow-up was then analyzed. RESULTS: Variation in the radiologists' accuracy, as measured with the SD of the area under the receiver operating characteristic curve, was reduced by 46% with computer aid. Access to the computer aid increased the agreement among all observers from 13% to 32% of the total cases (P < .001), while the κ value increased from 0.19 to 0.41 (P < .05). Use of computer aid eliminated two-thirds of the substantial disagreements in which two radiologists recommended biopsy and routine screening in the same patient (P < .05). CONCLUSION: In addition to its demonstrated potential to improve diagnostic accuracy, computer-aided diagnosis has the potential to reduce the variability among radiologists in the interpretation of mammograms. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast calcification (diagnosis) breast cancer (diagnosis) cancer screening EMTREE MEDICAL INDEX TERMS article computer assisted diagnosis controlled study diagnostic accuracy female human image analysis major clinical study observer variation priority journal radiologist reliability EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001306065 MEDLINE PMID 11526283 (http://www.ncbi.nlm.nih.gov/pubmed/11526283) PUI L32799991 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 500 TITLE National institutes of health consensus development conference statement: Adjuvant therapy for breast cancer, November 1-3, 2000 AUTHOR NAMES Bowersox J.A. AUTHOR ADDRESSES (Bowersox J.A.) Office Med. Applications of Research, National Institute of Health, Bldg. 31, Bethesda, MD 20892, United States. CORRESPONDENCE ADDRESS J.A. Bowersox, Office Med. Applications of Research, National Institute of Health, Bldg. 31, Bethesda, MD 20892, United States. Email: bowersoj@od.nih.gov SOURCE Journal of the National Cancer Institute (2001) 93:13 (979-989). Date of Publication: 4 Jul 2001 ISSN 0027-8874 BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Objective: Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. Participants: The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. Evidence: The literature was searched with the use of MEDLINE® for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. Consensus Process: The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://consensus.nih.gov. Conclusions: The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination. EMTREE DRUG INDEX TERMS anastrozole (pharmacology) anthracycline (adverse drug reaction, drug combination, drug comparison, drug dose, drug therapy) aromatase inhibitor (pharmacology) cyclophosphamide (drug combination, drug comparison, drug dose, drug therapy) docetaxel (clinical trial, drug combination, drug therapy) doxorubicin (adverse drug reaction, drug combination, drug comparison, drug dose, drug therapy) epirubicin (adverse drug reaction, drug combination, drug comparison, drug therapy) fluorouracil (drug combination, drug comparison, drug therapy) gonadorelin agonist (pharmacology) goserelin (pharmacology) hormone receptor (endogenous compound) paclitaxel (clinical trial, drug combination, drug therapy) raloxifene receptor protein (endogenous compound) tamoxifen (adverse drug reaction, clinical trial, drug combination, drug comparison, drug therapy, pharmacology) taxane derivative (clinical trial, drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adult advanced cancer aged amnesia (side effect) article biostatistics cancer adjuvant therapy cancer epidemiology cancer localization cancer patient cancer surgery cancer survival cardiotoxicity (side effect) clinical trial controlled clinical trial controlled study dose response early menopause (side effect) fatigue (side effect) female hair loss (side effect) health care personnel health care policy high risk patient hormonal therapy hot flush (side effect) human lymph node mastectomy medical decision making medical expert medical literature menopause metastasis (drug therapy) mucosa inflammation (side effect) nausea and vomiting (side effect) neutropenia (side effect) oncology online system pathology priority journal prospective study protein expression public health publication quality of life radiology randomized controlled trial statistical analysis thromboembolism (side effect) tumor recurrence vagina discharge (side effect) weight gain CAS REGISTRY NUMBERS anastrozole (120511-73-1) cyclophosphamide (50-18-0) docetaxel (114977-28-5) doxorubicin (23214-92-8, 25316-40-9) epirubicin (56390-09-1, 56420-45-2) fluorouracil (51-21-8) goserelin (65807-02-5) paclitaxel (33069-62-4) raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001260026 MEDLINE PMID 11438563 (http://www.ncbi.nlm.nih.gov/pubmed/11438563) PUI L32677397 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 501 TITLE A comparison of four treatment strategies for ductal carcinoma in situ using decision analysis AUTHOR NAMES Bordeleau L. Rakovitch E. Naimark D.M. Pritchard K.I. Ackerman I. Sawka C.A. AUTHOR ADDRESSES (Bordeleau L.; Rakovitch E., eileen.rakovitch@tsrcc.on.ca; Pritchard K.I.; Ackerman I.; Sawka C.A.) Toronto-Sunnybrook Regional Cancer Center, University of Toronto, Canada. (Naimark D.M.) Sunnybrook and Women's College, Health Sciences Center, University of Toronto, Toronto, Ont., Canada. (Bordeleau L.; Pritchard K.I.; Sawka C.A.) Department of Medical Oncology, University of Toronto, Toronto, Ont., Canada. (Rakovitch E., eileen.rakovitch@tsrcc.on.ca; Ackerman I.) Department of Radiation Oncology, University of Toronto, Toronto, Ont., Canada. (Naimark D.M.) Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ont., Canada. (Rakovitch E., eileen.rakovitch@tsrcc.on.ca) C/o Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ont. M4N 3M5, Canada. CORRESPONDENCE ADDRESS E. Rakovitch, Toronto-Sunnybrook Reg. Cancer Ctr., 2075 Bayview Avenue, Toronto, Ont. M4N 3M5, Canada. Email: eileen.rakovitch@tsrcc.on.ca SOURCE Cancer (2001) 92:1 (23-29). Date of Publication: 1 Jul 2001 ISSN 0008-543X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. The goals of the current study were to compare four treatment approaches in the management of ductal carcinoma in situ (DCIS), to determine the conditions where mastectomy may be preferred to breast-conserving therapy (BCT), and to determine conditions where the addition of tamoxifen produces better results than BCT alone. METHODS. A decision analysis model was used to compare four treatment approaches after local excision for DCIS: mastectomy, irradiation, irradiation plus adjuvant tamoxifen, or observation. The model weighed the potential benefits of each treatment approach (reduction of ipsilateral and/or contralateral breast carcinoma) against the potential risks of treatment-related toxicities. In addition, the model adjusted for the potential detrimental impact of local recurrence or treatment-related toxicity on health-related quality of life (HRQOL). Base-case estimates were obtained from published randomized trial data. One-way and two-way sensitivity analyses were performed. RESULTS. According to the model, the optimal treatment for DCIS was strongly dependent on the individual's risk of local recurrence and the patient's attitudes toward mastectomy. Mastectomy was preferred in patients whose estimated 10-year risk of local recurrence was > 15%, provided that mastectomy resulted in a very low reduction in quality of life (i.e., utility estimate > 0.97). Conditions where the addition of tamoxifen was preferred to breast-conserving therapy alone included the following: estimated 10-year risk of local recurrence > 38%, estimated 10-year risk of developing a contralateral breast carcinoma > 6%, or a significant decrement in HRQOL associated with the development of an invasive local recurrence or salvage mastectomy (utility estimates < 0.85). CONCLUSION. Based on this quality-adjusted model, BCT appeared to be the preferred treatment for DCIS. The most important determinants of optimal management for DCIS included the risk of local recurrence and the utility of mastectomy. Formal evaluation of utilities in the context of DCIS and more accurate determination of the risk of recurrence are required. © 2001 American Cancer Society. EMTREE DRUG INDEX TERMS tamoxifen (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) carcinoma in situ (drug therapy, radiotherapy, surgery) intraductal carcinoma (drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS article breast carcinoma (drug therapy, radiotherapy, surgery) cancer adjuvant therapy cancer recurrence female human mastectomy medical decision making priority journal quality of life side effect (side effect) CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001241904 MEDLINE PMID 11443605 (http://www.ncbi.nlm.nih.gov/pubmed/11443605) PUI L32623036 DOI 10.1002/1097-0142(20010701)92:1<23::AID-CNCR1287>3.0.CO;2-Y FULL TEXT LINK http://dx.doi.org/10.1002/1097-0142(20010701)92:1<23::AID-CNCR1287>3.0.CO;2-Y COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 502 TITLE An interactive CD-ROM concerning the choice between breast-conserving therapy and mastectomy: Positive evaluations from patients and surgeons ORIGINAL (NON-ENGLISH) TITLE Interactive CD-ROM over de keuze tussen borstsparende behandeling en amputative: Positieve reacties van patiënten en chirurgen AUTHOR NAMES Molenaar S. Sprangers M.A.G. Rutgers E.J.Th. Mulder H.J. Luiten E.J.T. De Haes J.C.J.M. AUTHOR ADDRESSES (Molenaar S.; Sprangers M.A.G.; Rutgers E.J.Th.; Mulder H.J.; Luiten E.J.T.; De Haes J.C.J.M.) Academisch Medisch Centrum, Medische Psychologie, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. CORRESPONDENCE ADDRESS S. Molenaar, Academisch Medisch Centrum, Medische Psychologie, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Email: j.molenaar@amc.uva.nl SOURCE Nederlands Tijdschrift voor Geneeskunde (2001) 145:21 (1004-1008). Date of Publication: 26 May 2001 ISSN 0028-2162 BOOK PUBLISHER Bohn Stafleu van Loghum, P.O. Box 246, Houten, Netherlands. ABSTRACT Objective. To assess how breast cancer patients and surgeons rate an interactive decision aid, using CD-ROM technology, developed to support a choice between breast-conserving therapy and mastectomy. Design. Questionnaire investigation. Method. Written questionnaires were presented to patients as soon as they had finished using the CD-ROM. They responded on a 5-point scale. Surgeons (n = 14) were sent a written questionnaire to investigate their experiences of using the CD-ROM program. Results. The interactive CD-ROM was offered to 92 consecutive breast cancer patients. Responses were obtained from 86 (93%) of the patients. The remainder were inadvertently not given the questionnaire. All of the patients evaluated the program as positive. Most of the patients found the program to be 'interesting', 'clear', 'useful', 'encouraging', and 'reassuring'. A majority (n = 76) expressed the view that the amount of information received was 'just right'. The interactive, computer-based method was evaluated as 'agreeable' by 74 patients. Almost all of the patients (n = 82) recommended that the program be shown to other patients. All of the surgeons (n = 14) stated that their patients' evaluations of the program were positive. Moreover, most of the surgeons (n = 10) were of the opinion that the program 'considerably contributed' to the provision of information. With the exception of one surgeon (n = 13), they all held the view that the program can be offered to breast cancer patients facing a choice between breast-conservation or mastectomy on a standard basis. Conclusion. Interactive decision-making support by means of a CD-ROM for patients with breast cancer, received positive evaluations from both the patients and surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) compact disk partial mastectomy software EMTREE MEDICAL INDEX TERMS adult aged article controlled study decision making female human major clinical study male questionnaire surgeon EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE Dutch LANGUAGE OF SUMMARY English, Dutch EMBASE ACCESSION NUMBER 2001210078 MEDLINE PMID 11407276 (http://www.ncbi.nlm.nih.gov/pubmed/11407276) PUI L32530966 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 503 TITLE Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer AUTHOR NAMES Goel V. Sawka C.A. Thiel E.C. Gort E.H. O'Connor A.M. AUTHOR ADDRESSES (Goel V., vivek.goel@utoronto.ca; Sawka C.A.; Thiel E.C.; Gort E.H.) Institute for Clinical Evaluative Sciences, Toronto. Ont., Canada. (Goel V., vivek.goel@utoronto.ca; Sawka C.A.) Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ont., Canada. (Goel V., vivek.goel@utoronto.ca) Department of Health Administration, University of Toronto, Toronto, Ont., Canada. (Sawka C.A.) Department of Medicine, University of Toronto, Toronto, Ont., Canada. (O'Connor A.M.) Faculty of Health Sciences, University of Ottawa, Ottawa, Ont., Canada. (Goel V., vivek.goel@utoronto.ca) Department of Health Administration, McMurrich Bldg., 12 Queen's Pk Cres. W., Toronto, Ont. M5S 1A8, Canada. CORRESPONDENCE ADDRESS V. Goel, Department of Health Administration, McMurrich Bldg, 12 Queen's Pk Cres. W., Toronto, Ont. M5S 1A8, Canada. Email: vivek.goel@utoronto.ca SOURCE Medical Decision Making (2001) 21:1 (1-6). Date of Publication: 2001 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT A decision aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The decision aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the decision aid or a control pamphlet. Patients completed a questionnaire prior to using the decision aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or decisional regret across the 2 groups. There was a nonsignificant trend toward lower decisional conflict in the decision aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict. Although the decision aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate decision support interventions should be developed and evaluated. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) EMTREE MEDICAL INDEX TERMS adult article clinical trial conflict controlled clinical trial controlled study female human major clinical study mastectomy medical decision making patient counseling patient guidance randomized controlled trial treatment indication EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001121057 MEDLINE PMID 11206942 (http://www.ncbi.nlm.nih.gov/pubmed/11206942) PUI L32245025 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 504 TITLE ONCODOC: A successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer AUTHOR NAMES Séroussi B. Bouaud J. Antoine E.-C. AUTHOR ADDRESSES (Séroussi B., bs@biomath.jussieu.fr; Bouaud J., jb@biomath.jussieu.fr) Service d'Informatique Médicale, DSI/AP-HP - Departement de Biomatiques, Universite Paris 6, Paris, France. (Antoine E.-C., antoine.eric-charles@wanadoo.fr) Service d'Oncologie Médicale, Groupe Hospitalier Pitie-Salpetriere, Paris, France. (Antoine E.-C., antoine.eric-charles@wanadoo.fr) Service de Informatique, 91 boulevard le, Hopital, 75634, Paris cedex 13, France. CORRESPONDENCE ADDRESS B. Séroussi, Service Informatique Médicale, DSI/AP-HP, Université Paris 6, Paris, France. Email: bs@biomath.jussieu.fr SOURCE Artificial Intelligence in Medicine (2001) 22:1 (43-64). Date of Publication: 2001 ISSN 0933-3657 BOOK PUBLISHER Elsevier, P.O. Box 211, Amsterdam, Netherlands. ABSTRACT Originally published as textual documents, clinical practice guidelines have poorly penetrated medical practice because their editorial properties do not allow the reader to easily solve, at the point of care, a given medical problem. However, despite the proliferation of implemented clinical practice guidelines as decision support systems providing an easy access to patient-centered information, there is still little evidence of high physician compliance to guidelines recommendations. Apart from physicians' psychological reluctance, the incompleteness of guideline knowledge and the impreciseness of the terms used, another reason may be that, although suited to average patients, clinical practice guideline recommendations are not a substitute for the physician-controlled clinical judgement that should be applied to each actual individual patient. Therefore, computer-based approaches based on the automation of context-free operationalization of guideline knowledge, although providing uniform optimal strategies to problem-focused care delivery, may generate inappropriate inferences for a specific patient that the physician does not follow in practice. Rather than providing automated decision support, ONCODOC allows the clinician to control the operationalization of guideline knowledge through his hypertextual reading of a knowledge base encoded as a decision tree. In this way, he has the opportunity to interpret the information provided in the context of his patient, therefore, controlling his categorization to the closest matching formal patient. Experimented in life-size ONCODOC demonstrated good appropriation of the system by physicians with significantly high scores of compliance. We successfully tested the implemented strategy and the knowledge base in a second medical institution, giving then a noticeable example of reuse and sharing of encoded guideline knowledge across institutions. Copyright © 2001 Elsevier Science B.V. EMTREE DRUG INDEX TERMS anthracycline antibiotic agent (drug therapy) steroid receptor (endogenous compound) tamoxifen citrate (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computer aided design practice guideline EMTREE MEDICAL INDEX TERMS aged article asthenia (complication) bone metastasis (diagnosis) breast carcinoma (diagnosis, drug therapy, radiotherapy, surgery) cancer staging case report compliance (physical) decision making female health care delivery hormonal therapy human information processing lymph node metastasis (diagnosis, surgery) pain (complication) physician priority journal problem solving process control DRUG TRADE NAMES nolvadex DEVICE TRADE NAMES OncoDoc computer program CAS REGISTRY NUMBERS tamoxifen citrate (54965-24-1) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001095538 MEDLINE PMID 11259883 (http://www.ncbi.nlm.nih.gov/pubmed/11259883) PUI L32203684 DOI 10.1016/S0933-3657(00)00099-3 FULL TEXT LINK http://dx.doi.org/10.1016/S0933-3657(00)00099-3 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 505 TITLE Decision support for patients with early-stage breast cancer: Effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life AUTHOR NAMES Molenaar S. Sprangers M.A.G. Rutgers E.J.Th. Luiten E.J.T. Mulder J. Bossuyt P.M.M. Van Everdingen J.J.E. Oosterveld P. De Haes H.C.J.M. AUTHOR ADDRESSES (Molenaar S.; Sprangers M.A.G.; Rutgers E.J.Th.; Luiten E.J.T.; Mulder J.; Bossuyt P.M.M.; Van Everdingen J.J.E.; Oosterveld P.; De Haes H.C.J.M.) Academic Medical Center, University of Amsterdam, Dept. of Medical Psychology (J4-401), P.O. BOX 22 660, 1100 DD Amsterdam, Netherlands. CORRESPONDENCE ADDRESS S. Molenaar, Academic Medical Center, University of Amsterdam, Dept. of Medical Psychology (J4-401), P.O. BOX 22 660, 1100 DD Amsterdam, Netherlands. Email: J.Molenaar@AMC.UvA.NL SOURCE Journal of Clinical Oncology (2001) 19:6 (1676-1687). Date of Publication: 15 Mar 2001 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: To investigate the effects of the Interactive Breast Cancer CDROM as a decision aid for breast cancer patients with a choice between breast conserving therapy (BCT) and mastectomy (MT). Patients and Methods: Consecutive patients with stage I and II breast cancer were enrolled. A quasiexperimental, longitudinal, and pretest/posttest design was used. Follow-up was scheduled 3 and 9 months after discharge from the hospital. Control patients (n = 88) received standard care (oral information and brochures). The CDROM was provided to patients in the experimental condition (n = 92) as a supplement to standard procedures. Outcome variables were treatment decision, satisfaction, and quality of life (QoL). Results: No effect on treatment decision was found. CDROM patients expressed more general satisfaction with information at 3 and 9 months (95% confidence interval for the difference (d) between the means (d: 4.1 to 12.5 and 5.7 to 14.2 respectively). CDROM patients were also more satisfied with their treatment decision at 3 and at 9 months (d: 0.1 to 0.4; 0.2 to 0.5). Moreover, at 9 months, CDROM patients were more satisfied with breast cancer-specific information (d: 0.9 to 16.5), the decision-making process (d: 0.1 to 0.4), and communication (d: 0.2 to 11.0). At 3 and 9 months, a positive effect was found on general health (d: 0.2 to 14.5 and 0.3 to 15.0). Moreover, at 9 months, CDROM patients reported better physical functioning (d: 5.1 to 19.8), less pain (d: -17.9 to -4.5), and fewer arm symptoms (d: -14.1 to -0.5). Conclusion: The Interactive Breast Cancer CDROM improved decision making in patients with early-stage breast cancer with a choice between BCT and MT, as evaluated in terms of patients' satisfaction and QoL. © 2001 by American Society of Clinical Oncology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) EMTREE MEDICAL INDEX TERMS adult aged article clinical trial compact disk controlled clinical trial controlled study female human intermethod comparison major clinical study mastectomy medical decision making patient guidance priority journal randomized controlled trial software treatment indication EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001110703 MEDLINE PMID 11250997 (http://www.ncbi.nlm.nih.gov/pubmed/11250997) PUI L32230868 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 506 TITLE Benefits and costs of genetic screening for breast cancer AUTHOR NAMES Grann V.R. Jacobson J.S. AUTHOR ADDRESSES (Grann V.R.; Jacobson J.S.) Herbert Irving Compreh. Cancer Ctr., College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, United States. CORRESPONDENCE ADDRESS V.R. Grann, Herbert Irving Compreh. Cancer Ctr., College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, United States. SOURCE Community Genetics (2000) 3:4 (190-192). Date of Publication: 2000 ISSN 1422-2795 ABSTRACT Genetic testing for breast cancer will soon become widely available, but the principles for evaluating its benefits and costs, from a policy perspective, have not been described. The benefits and costs of screening for breast cancer depend on the following factors: prevalence and penetrance, the mortality associated with the disease, age at testing, and the potential effects of preventive measures on risk of developing the disease, quality of life, and costs. In this paper, the epidemiological principles that describe the relationship of testing to survival, quality-adjusted survival, and cost-effectiveness are presented and illustrated by examples drawn from decision analyses of genetic testing for breast cancer. Conclusions indicate that all the aforementioned factors may affect the health outcomes with which public policy is concerned and should be considered when evaluating genetic tests. Copyright © 2001 S. Karger AG, Basel. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein BRCA2 protein raloxifene (drug therapy, pharmacoeconomics) selective estrogen receptor modulator (drug therapy, pharmacoeconomics) tamoxifen (drug therapy, pharmacoeconomics) EMTREE DRUG INDEX TERMS estrogen receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, disease management, drug therapy, epidemiology, etiology, prevention, surgery) cost benefit analysis genetic screening ovary cancer (diagnosis, disease management, epidemiology, etiology, prevention) EMTREE MEDICAL INDEX TERMS cancer chemotherapy cancer mortality cancer prevention cancer risk cancer survival conference paper cost effectiveness analysis female gene mutation health care cost health care policy human mastectomy priority journal quality of life CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Human Genetics (22) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001186385 PUI L32463991 DOI 10.1159/000051137 FULL TEXT LINK http://dx.doi.org/10.1159/000051137 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 507 TITLE Adjuvant therapy for breast cancer. AUTHOR ADDRESSES SOURCE NIH consensus statement (2000) 17:4 (1-35). Date of Publication: 2000 Nov 1-3 ISSN 1080-1707 ABSTRACT OBJECTIVE: To provide health care providers, patients, and the general public with a current consensus on various issues related to the use of adjuvant therapy for breast cancer. PARTICIPANTS: A nonfederal, nonadvocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, health policy, and the public; 30 experts in medical oncology, molecular oncology, biostatistics, epidemiology, surgical oncology, and clinical trials who presented data to the consensus panel; a conference audience of approximately 1,000. EVIDENCE: The literature was searched using MEDLINE and an extensive bibliography of references was provided to the panel. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. CONCLUSIONS: During the past 10 years, substantial progress has been made in the treatment of invasive breast cancer. For the first time, breast cancer mortality rates are decreasing in the United States. Refinements of adjuvant treatment have contributed to this advance. Generally accepted prognostic and predictive factors include age, tumor size, lymph node status, histological tumor type, grade, mitotic rate, and hormonal receptor status. Novel technologies, such as tissue and expression microarrays and proteomics, hold exciting potential. Progress, however, will depend on proper design and analysis of clinical and pathological investigations. Decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of nodal, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if they have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of post-mastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality-of-life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS antineoplastic hormone agonists and antagonists (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy (adverse drug reaction) adjuvant therapy (adverse drug reaction) conference paper consensus development female human methodology pathology patient selection quality of life LANGUAGE OF ARTICLE English MEDLINE PMID 11512506 (http://www.ncbi.nlm.nih.gov/pubmed/11512506) PUI L33509478 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 508 TITLE How to estimate treatment effects from reports of clinical trials. I: Continuous outcomes AUTHOR NAMES Herbert R.D. AUTHOR ADDRESSES (Herbert R.D.) School of Physiotherapy, University of Sydney, Post Office Box 170, Lidcombe, NSW 1825, Australia. CORRESPONDENCE ADDRESS R.D. Herbert, School of Physiotherapy, University of Sydney, Post Office Box 170, Lidcombe, NSW 1825, Australia. Email: r.herbert@cchs.usyd.edu.au SOURCE Australian Journal of Physiotherapy (2000) 46:3 (229-235). Date of Publication: 2000 ISSN 0004-9514 ABSTRACT Properly conducted randomised trials can aid clinical decision-making by providing unbiased estimates of the average size of treatment effects. This paper, the first of two, discusses how readers of clinical trials can extract simple estimates of treatment effect size from trial reports when trial outcomes are measured on a continuous scale. When making decisions about therapy for individual patients, these estimates can be modified on the basis of patient characteristics. Modified estimates of treatment effect size can be used to determine if the effect of treatment is likely to be large enough to be 'clinically worthwhile'. This approach optimises clinical decision-making by combining unbiased estimates of the size of treatment effect from clinical trials with clinical intuition and patient preferences. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) outcomes research EMTREE MEDICAL INDEX TERMS breast disease (surgery) clinical research compression therapy cost benefit analysis decision making evidence based medicine human lymphedema (complication, disease management, therapy) mastectomy review treatment outcome EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000320374 PUI L30686942 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 509 TITLE Enhancing cancer clinical trial management: Recommendations from a qualitative study of trial participants' experiences AUTHOR NAMES Bultz B.D. Speca M. Brasher P.M. Geggie P.H.S. Page S.A. AUTHOR ADDRESSES (Bultz B.D., bdbultz@acs.ucalgary.ca; Speca M.) Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board, Canada. (Bultz B.D., bdbultz@acs.ucalgary.ca) Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Canada. (Brasher P.M.) Division of Epidemiology, Prevention and Screening, Alberta Cancer Board, Canada. (Geggie P.H.S.) Department of Medicine, Tom Baker Cancer Centre, Alberta Cancer Board, Canada. (Page S.A.) Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Canada. (Bultz B.D., bdbultz@acs.ucalgary.ca) Department of Psychosocial Resources, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alta. T2N 4N2, Canada. CORRESPONDENCE ADDRESS K. Cox, School of Nursing, Medical School, University of Nottingham, Nottingham NG7 2UH, United Kingdom. Email: karen.cox@nottingham.ac.uk SOURCE Psycho-Oncology (2000) 9:4 (314-322). Date of Publication: 2000 ISSN 1057-9249 BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. ABSTRACT Using a qualitative approach, a total of 55 adult patients with advanced cancer were interviewed to examine their perceptions of participating in early phase anti-cancer drug trials. Patients' views and experiences were explored, primarily through the use of in-depth interviews, with additional information accessed through two widely-used quality of life questionnaires, at the beginning of, during and after trial participation. The picture of trial participation established from this work suggests that it is a dynamic process, that has different meaning and impact according to the stage of trial involvement the patient is experiencing. The findings identify how patients perceived the offer of the trial, dealt with the trial treatment, and came to terms with trial conclusion. The insight and understanding that this work provides in terms of the impact of trial involvement over time as well as details of patients' information, decision-making and support needs has significant implications for cancer clinical trial management. The recommendation put forward in this paper focus on acknowledging the contribution trial participants make to cancer research, enhancing the process of preparing patients for trial participation, recognizing the need for continuing care, the incorporation of patients and potential patients' views into the clinical trials system, and educating the public about clinical trials. Copyright (C) 2000 John Wiley and Sons, Ltd. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (clinical trial, drug therapy) EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) malignant neoplasm (drug therapy, prevention) EMTREE MEDICAL INDEX TERMS adult advanced cancer (drug therapy, prevention) aged article breast cancer (drug therapy, prevention) cancer research clinical trial decision making digestive system cancer (drug therapy, prevention) female follow up health education human lung cancer (drug therapy, prevention) major clinical study male phase 1 clinical trial phase 2 clinical trial psychologic test qualitative diagnosis quality of life social psychology EMBASE CLASSIFICATIONS Cancer (16) Psychiatry (32) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000299487 MEDLINE PMID 10960929 (http://www.ncbi.nlm.nih.gov/pubmed/10960929) PUI L30649357 DOI 10.1002/1099-1611(200007/08)9:4<314::AID-PON464>3.0.CO;2-C FULL TEXT LINK http://dx.doi.org/10.1002/1099-1611(200007/08)9:4<314::AID-PON464>3.0.CO;2-C COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 510 TITLE Mammography use among women as a function of age and patient involvement in decision-making AUTHOR NAMES Burack R.C. George J. Gurney J.G. AUTHOR ADDRESSES (Burack R.C.; George J.) Department of Internal Medicine, Wayne State University, Detroit, MI, United States. (Burack R.C.; George J.) Barbara Ann Karmanos Cancer Inst., Detroit, MI, United States. (Gurney J.G.) Department of Pediatrics, Div. of Epidemiol./Clinical Research, University of Minnesota, Minneapolis, MN, United States. (Burack R.C.) University Health Center (5-C), 4201 St. Antoine, Detroit, MI 48201, United States. CORRESPONDENCE ADDRESS R.C. Burack, University Health Center, 4201 St. Antoine, Detroit, MI 48201, United States. SOURCE Journal of the American Geriatrics Society (2000) 48:7 (817-821). Date of Publication: July 2000 ISSN 0002-8614 BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT OBJECTIVE: To assess the extent to which self-reported patient involvement in decision-making for initiation of mammography differs with age. DESIGN: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement were evaluated. Prevalences were weighted and variances were adjusted using SUDAAN software to account for the complex, multistage sampling probability design of the NHIS. Logistic regression was used to evaluate the relative likelihood of self-reported involvement in the decision to have a mammogram within the preceding year as a function of age and other covariates. PARTICIPANTS: Mammography use was assessed among 3863 NHIS female respondents 40 years of age or older. The analysis of decision- making was restricted to the subgroup of 1064 women who reported a screening mammogram within the preceding year and who provided information on the other relevant variables. MEASUREMENTS AND MAIN RESULTS: The probability of reported mammography use within the preceding year declines among older groups of interviewees. Among women with a mammogram in the preceding year, the weighted percentage of women reporting active involvement in the decision (patient decision or decided jointly with a physician) declines from 51% among women 40 to 45 years of age to 19% among those aged 75 years or older. The adjusted odds ratio comparing the likelihood of participating in the decision to have a mammogram for the oldest women, compared with the youngest, was 0.31 (95% confidence interval 0.15 to 0.61). CONCLUSIONS: Older women are substantially less likely than younger women to report active involvement in the mammography decision-making process. Increased use of screening mammography among older women will require greater promotion by physicians. Other interventions, such as directed educational efforts, may also be needed to increase mammography demand among older women. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) age breast cancer (diagnosis) mammography medical decision making patient attitude EMTREE MEDICAL INDEX TERMS adult aged article cancer control cancer diagnosis cancer screening female human major clinical study patient education physician attitude screening test self report EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Gerontology and Geriatrics (20) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000251206 MEDLINE PMID 10894323 (http://www.ncbi.nlm.nih.gov/pubmed/10894323) PUI L30457422 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 511 TITLE Lessons learned from the Decision Board: A unique and evolving decision aid AUTHOR NAMES Whelan T. Gafni A. Charles C. Levine M. AUTHOR ADDRESSES (Whelan T., tim.whelan@hrcc.on.ca; Gafni A.; Charles C.; Levine M.) McMaster University, Hamilton, Ont., Canada. (Whelan T., tim.whelan@hrcc.on.ca) Supportive Cancer Care Research Unit, Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ont. L8V 5C2, Canada. CORRESPONDENCE ADDRESS T. Whelan, Supportive Cancer Care Research Unit, Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ont. LSV 5C2, Canada. Email: tim.whelan@hrcc.on.ca SOURCE Health Expectations (2000) 3:1 (69-76). Date of Publication: 2000 ISSN 1369-6513 ABSTRACT One session of the conference was devoted to the presentation of different types of decision aids. This paper reports the experience and lessons learned through the development and use of the Decision Board. This is a uniquely interactive decision aid administered by the clinician during the medical consultation. The instrument has been developed in a number of clinical contexts, primarily regarding treatment options for cancer patients. Studies have shown the instrument to improve patient understanding and facilitate the shared decision-making process. Randomized trials are ongoing, evaluating the addition of the Decision Board to the traditional medical consultation. The instrument continues to evolve to meet patients' need for information and flexibility in presentation. Computer-based versions of the Decision Board are currently being developed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management, surgery) medical decision making EMTREE MEDICAL INDEX TERMS cancer adjuvant therapy cancer patient cancer surgery conference paper doctor patient relation human major clinical study physician priority journal quality of life risk benefit analysis EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000121918 PUI L30182797 DOI 10.1046/j.1369-6513.2000.00084.x FULL TEXT LINK http://dx.doi.org/10.1046/j.1369-6513.2000.00084.x COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 512 TITLE Patient participation in medical decision-making: A French study in adjuvant radio-chemotherapy for early breast cancer AUTHOR NAMES Protière C. Viens P. Genre D. Cowen D. Camerlo J. Gravis G. Alzieu C. Bertucci F. Resbeut M. Maraninchi D. Moatti J.-P. AUTHOR ADDRESSES (Viens P.; Genre D.; Cowen D.; Camerlo J.; Gravis G.; Alzieu C.; Bertucci F.; Resbeut M.; Maraninchi D.) Institut Paoli-Calmettes, Regional Centre for Cancer Care, Marseilles, France. (Protière C.; Genre D.; Moatti J.-P.) INSERM U379 'Social Sci. Appl. M., Marseilles, France. (Protière C.; Viens P.; Maraninchi D.; Moatti J.-P.) University of the Mediterranean, Marseilles, France. (Moatti J.-P.) INSERM U379, Institut Paoli-Calmettes, 232 Bd. Sainte Marguerite, 13273 Marseilles, Cedex 9, France. CORRESPONDENCE ADDRESS J.-P. Moatti, INSERM U379, Institut Paoli-Calmettes, 232 Bd. Sainte Marguerite, 13273 Marseilles, Cedex 9, France. SOURCE Annals of Oncology (2000) 11:1 (39-45). Date of Publication: 2000 ISSN 0923-7534 BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Background: Shared decision-making is increasingly advocated as an ideal model. However, very few studies have tested the feasibility of giving patients the opportunity to participate in the choice of treatment. Patients and methods: Women, with non-metastatic breast cancer, eligible for non- intensified adjuvant chemotherapy attending our hospital were proposed two administrations of chemotherapy and radiotherapy: a sequential and a concomitant one. Two patient-questionnaires were used to elicit motivations for their choice and their degree of comfort with the process of decision- making and one questionnaire to test physicians' ability to predict patients' choice. Results: Participation rate in the study was 75.3% (n = 64). Majority (64%) of patients chose the concomitant treatment. Multivariate analysis revealed that patients with a lower level of education, who discussed the choice with social circle, and who most feared side-effects were more likely to choose the sequential treatment. Physicians were able to predict patients' choice in 66% of cases. 89% of patients declared that they were |fully satisfied| with having participated in the choice of treatment and 79% supported shared decision-making. Conclusions: Results are in favour of promoting active participation of cancer-patients in medical decision-making. The adequate degree of such participation remains however to be elicited and tested for therapeutic choices implying more difficult trade-offs between quantity and quality of life. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS cyclophosphamide (drug combination, drug therapy) mitoxantrone (drug combination, drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, radiotherapy) cancer adjuvant therapy cancer chemotherapy cancer radiotherapy EMTREE MEDICAL INDEX TERMS article cancer patient doctor patient relation female human major clinical study medical decision making patient right priority journal quality of life CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) mitoxantrone (65271-80-9, 70476-82-3) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000057935 MEDLINE PMID 10690385 (http://www.ncbi.nlm.nih.gov/pubmed/10690385) PUI L30084577 DOI 10.1023/A:1008390027720 FULL TEXT LINK http://dx.doi.org/10.1023/A:1008390027720 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 513 TITLE Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA 1/2 -positive women: A decision analysis AUTHOR NAMES Grann V.R. Jacobson J.S. Whang W. Hershman D. Heitjan D.F. Antman K.H. Neugut A.I. AUTHOR ADDRESSES (Grann V.R.; Jacobson J.S.; Whang W.; Hershman D.; Heitjan D.F.; Antman K.H.; Neugut A.I.) Herbert Irving Compreh. Can. Ctr., Columbia University, PH18-201A, 630 West 168th Street, New York, NY 10032, United States. CORRESPONDENCE ADDRESS V.R. Grann, Herbert Irving Compreh. Can. Ctr., Columbia University, PH18-201A, 630 West 168th Street, New York, NY 10032, United States. SOURCE Cancer Journal from Scientific American (2000) 6:1 (13-20). Date of Publication: 2000 ISSN 1081-4442 BOOK PUBLISHER Scientific American Inc., 415 Madison Avenue, New York, United States. ABSTRACT PURPOSE: Recent randomized controlled trials have shown that tamoxifen and raloxifene may prevent invasive breast cancer. This decision analysis study compares the outcomes of chemoprevention with tamoxifen, raloxifene, or oral contraceptives with the outcomes of prophylactic surgery among women with high-risk BRCA 1/2 mutations. PATIENTS AND METHODS: We used a simulated cohort of 30-year-old women who tested positive for BRCA 1/2 mutations and constructed a Markov model with Monte Carlo simulations, incorporating cumulative breast and ovarian cancer incidence rates from the literature and survival figures from SEER data. We assumed that prophylactic surgery reduces ovarian cancer risk by 45% and breast cancer risk by 90%, that tamoxifen reduces invasive breast cancer risk by 49%, and that raloxifene has similar efficacy and safety in premenopausal and postmenopausal women. We used data obtained from high-risk women by a time trade-off questionnaire to calculate quality-adjusted life-years. We based our cost estimates for hospital and ambulatory care on Health Care Financing Administration payments, the SEER- HCFA database, and the Pharmacy Fundamental Reference. RESULTS: In our model, a 30-year-old BRCA 1/2 (+) woman could prolong survival by 0.9 years (95% probability interval, 0.4-1.2 years) by having bilateral oophorectomy, 3.4 years (2.7-3.7 years) by having bilateral mastectomy, and 4.3 years (3.6-4.6 years) by having both procedures instead of surveillance alone. Chemoprevention with tamoxifen and raloxifene increased survival by 1.6 years (1.0-2.1 years) and 2.2 years (1.3-2.8 years), respectively. Chemoprevention yielded more quality-adjusted life-years than did prophylactic surgery, even when treatment was delayed to age 40 or 50 years. All these procedures were cost-effective or cost-saving compared with surveillance alone. DISCUSSION: Our model suggests that although surgery may yield more substantial survival and cost benefits, quality of life issues may make chemoprevention a more attractive option for young women at high genetic risk. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tamoxifen (drug therapy, pharmacoeconomics) EMTREE DRUG INDEX TERMS oral contraceptive agent (drug therapy, oral drug administration, pharmacoeconomics) raloxifene (drug therapy, pharmacoeconomics) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer prevention ovary cancer (disease management, drug therapy, prevention, surgery) EMTREE MEDICAL INDEX TERMS adult article cancer model cancer survival cancer susceptibility chemoprophylaxis controlled study cost effectiveness analysis drug cost female genetic predisposition human major clinical study medical decision making ovariectomy priority journal probability quality adjusted life year system analysis CAS REGISTRY NUMBERS raloxifene (82640-04-8, 84449-90-1) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000053695 MEDLINE PMID 10696733 (http://www.ncbi.nlm.nih.gov/pubmed/10696733) PUI L30078500 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 514 TITLE Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations AUTHOR NAMES Schrag D. Kuntz K.M. Garber J.E. Weeks J.C. AUTHOR ADDRESSES (Schrag D.; Garber J.E.; Weeks J.C.) Department of Adult Oncology, Boston, MA, United States. (Schrag D.) Ctr. for Outcomes and Plcy. Research, Boston, MA, United States. (Kuntz K.M.) Dana-Farber Cancer Institute, Dept. of Hlth. Policy and Management, Harvard School of Public Health, Boston, United States. (Schrag D.) Health Outcomes Research Group, Dept. of Epidemiol. and Biostatist., Mem. Sloan-Kettering Cancer Center, New York, NY, United States. (Schrag D.) Mem. Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, United States. CORRESPONDENCE ADDRESS D. Schrag, Memorial Sloan-Kettering Can. Center, 1275 York Ave, New York, NY 10021, United States. SOURCE Journal of the American Medical Association (2000) 283:5 (617-624). Date of Publication: 2 Feb 2000 ISSN 0098-7484 BOOK PUBLISHER American Medical Association, 515 North State Street, Chicago, United States. ABSTRACT Context. Women with BRCA1- or BRCA2-associated breast cancer are at increased risk for contralateral breast cancer and ovarian cancer and therefore may consider secondary cancer prevention strategies, such as prophylactic surgery and tamoxifen therapy. It is not proven to what extent these strategies reduce risk of second cancers in such patients. Objective. To examine the effect of tamoxifen therapy, bilateral prophylactic oophorectomy (PO), prophylactic contralateral mastectomy (PCM), and combinations of these strategies on life expectancy for women with unilateral breast cancer and a BRCA1 or BRCA2 gene mutation. Design and Setting. Decision analysis using a Markov model. Probabilities for developing contralateral breast cancer and ovarian cancer, dying from these cancers, dying from primary breast cancer, and the reduction in cancer incidence and mortality due to prophylactic surgeries and/or tamoxifen were estimated from published studies. Participants. Hypothetical breast cancer patients with BRCA1 or BRCA2 mutations facing decisions about secondary cancer prevention strategies. Interventions. Seven strategies, including 5 years of tamoxifen use, PO, PCM, and combinations of these strategies, compared with careful surveillance. Main Outcome Measures. Total and incremental life expectancy (LE) with each intervention strategy. Results. Depending on the assumed penetrance of the BRCA mutation, compared with surveillance alone, 30-year- old early-stage breast cancer patients with BRCA mutations gain in LE 0.4 to 1.3 years from tamoxifen therapy, 0.2 to 1.8 years from PO, and 0.6 to 2.1 years from PCM. The magnitude of these gains is least for women with low- penetrance mutations (assumed contralateral breast cancer risk of 24% and ovarian cancer risk of 6%) and greatest for those with high-penetrance mutations (assumed contralateral breast cancer risk of 65% and ovarian cancer risk of 40%.) Older age and poorer prognosis from primary breast cancer further attenuate these gains. Conclusions. Interventions to prevent second cancers, particularly PCM, may offer substantial LE gain for young women with BRCA-associated early-stage breast cancer. Estimates of LE gain may help women and their physicians consider the uncertainties, risks, and advantages of these interventions and lead to more informed choices about cancer prevention strategies. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, epidemiology, etiology, prevention, surgery) life expectancy second cancer (complication, drug therapy, prevention) EMTREE MEDICAL INDEX TERMS article cancer mortality cancer prevention cancer risk gene mutation mastectomy ovariectomy ovary cancer priority journal probability CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Human Genetics (22) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000046782 MEDLINE PMID 10665701 (http://www.ncbi.nlm.nih.gov/pubmed/10665701) PUI L30069177 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 515 TITLE Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: Preliminary results AUTHOR NAMES Stalmeier P.F.M. Unic I.J. Verhoef L.C.G. Van Daal W.A.J. AUTHOR ADDRESSES (Stalmeier P.F.M., Stalmeier@nici.kun.nl) NICI, P.O. Box 9104, 6500 HE Nijmegen, Netherlands. (Unic I.J.; Verhoef L.C.G.; Van Daal W.A.J.) CORRESPONDENCE ADDRESS P.F.M. Stalmeier, NICI, P.O. Box 9104, 6500 HE Nijmegen, Netherlands. Email: stalmeier@nici.kun.nl SOURCE Medical Decision Making (1999) 19:3 (230-241). Date of Publication: July/September 1999 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background. Women suspected to have a genetic predisposition to breast cancer face the difficult choice between regular breast cancer screening and prophylactic mastectomy. The authors developed a shared decision making program (SDMP) to support this decision. Objectives. To evaluate the SDMP in terms of practicality, beneficial effects, and patient satisfaction. Design. A one-group pretest-posttest design was used. Measures. Decision uncertainty, decision burden, subjective knowledge, and risk comprehension were assessed before and after the SDMP. Additional measures were obtained for concepts related to breast cancer concern, desire to participate in the program, satisfaction, program acceptability, and emotional reaction to the program information. Results. Seventy-two women, most of whom were awaiting the genetic test results, participated. Decision uncertainty (effect size d = 0.37) and decision burden (d = 0.41) were reduced by the SDMP. Subjective knowledge (averaged d= 0.94) and risk comprehension were improved. The women were satisfied with the SDMP and found its rationale acceptable. Women who had strong emotional reactions to the information benefited less from the SDMP, whereas women with strong desires to participate in the decision benefited more. Conclusions. There is a need to give patients more information, especially about prophylactic mastectomy and among gene carriers. Beneficial effects were observed irrespective of whether genetic status was known, suggesting that information concerning treatment options should be made available as soon as DNA testing begins. The better psychological outcomes of women with stronger desires to participate may arise because the desire to participate is characteristic of emotional stability. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer susceptibility genetic predisposition medical decision making EMTREE MEDICAL INDEX TERMS article cancer screening DNA determination doctor patient relation emotion female genetic risk human major clinical study mastectomy Netherlands patient attitude patient compliance patient counseling patient information patient satisfaction EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999240912 MEDLINE PMID 10424830 (http://www.ncbi.nlm.nih.gov/pubmed/10424830) PUI L29321265 DOI 10.1177/0272989X9901900302 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X9901900302 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 516 TITLE Offering a choice between two adjuvant chemotherapy regimens: A pilot study to develop a decision aid for women with breast cancer AUTHOR NAMES Irwin E. Arnold A. Whelan T.J. Reyno L.M. Cranton P. AUTHOR ADDRESSES (Irwin E.) McMaster University, School of Nursing, 1200 Main Street West, Hamilton, Ont. L8N 3Z5, Canada. (Arnold A.; Whelan T.J.; Reyno L.M.) Department of Medicine, 1200 Main Street West, Hamilton, Ont. L8N 3Z5, Canada. (Irwin E.; Arnold A.; Whelan T.J.; Reyno L.M.) OCTRF Hamilton Reg. Cancer Centre, 699 Concession St., Hamilton, Ont. L8V 5C2, Canada. (Cranton P.) Brock University, Faculty of Education, 500 Glenridge Ave., St. Catharines, Ont. L2S 3A1, Canada. CORRESPONDENCE ADDRESS E. Irwin, McMaster University, School of Nursing, 1200 Main Street West, Hamilton, Ont. L8N 3Z5, Canada. SOURCE Patient Education and Counseling (1999) 37:3 (283-291). Date of Publication: July 1999 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Background: The primary objective of this study was to develop a decision aid which would encourage and assist patients to become involved in treatment decision making, and help clinicians to objectively educate patients about the benefits and risks of adjuvant chemotherapy for breast cancer. A secondary objective was to investigate the factors influencing this treatment decision-making process for women when choosing between adriamycin and cyclophosphamide (AC) versus cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy. Methods: An educational visual instrument called a Decision Board was developed consisting of written and graphical material. The Decision Board displays general information about chemotherapy and detailed information about each chemotherapy regimen, including the schedule and side effects, and was presented to patients with a scripted standardized oral explanation. The instrument was evaluated in 46 premenopausal women newly diagnosed with node-positive breast cancer. Following presentation of the board, the patients were given a take-home version to review and asked to return 1-2 weeks later with a decision. During the second visit each patient was asked to complete a questionnaire regarding demographics, learning and comprehension, treatment preference, and factors influencing their decision. Results: Recall of information was acceptable (≥ 80%). The Decision Board was found helpful by all, but the level of difficulty with decision making was variable. Out of 46 women, 23 women chose AC, 21 chose CMF, and two chose no treatment. The major factors affecting treatment preference were related to the impact on quality of life, the length of therapy, and the side effects, in particular, vomiting and alopecia. Conclusions: The Decision Board appears to be a valuable educational tool that enables patients to become well-informed and directly involved in their treatment decisions. EMTREE DRUG INDEX TERMS antineoplastic agent (adverse drug reaction, drug combination, drug comparison, drug therapy) cyclophosphamide (adverse drug reaction, drug combination, drug comparison, drug therapy) doxorubicin (adverse drug reaction, drug combination, drug comparison, drug therapy) fluorouracil (adverse drug reaction, drug combination, drug comparison, drug therapy) methotrexate (adverse drug reaction, drug combination, drug comparison, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) cancer adjuvant therapy EMTREE MEDICAL INDEX TERMS adult alopecia (side effect) article clinical article comprehension demography drug choice female human intravenous drug administration learning medical decision making patient education priority journal quality of life questionnaire risk benefit analysis vomiting (side effect) CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) methotrexate (15475-56-6, 59-05-2, 7413-34-5) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999237443 MEDLINE PMID 14528554 (http://www.ncbi.nlm.nih.gov/pubmed/14528554) PUI L29317322 DOI 10.1016/S0738-3991(98)00117-7 FULL TEXT LINK http://dx.doi.org/10.1016/S0738-3991(98)00117-7 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 517 TITLE Patient-centred consultation of clinical practice guidelines: OncoDoc, a decision support system for the management of breast cancer patients ORIGINAL (NON-ENGLISH) TITLE Consultation centree-patient d'un 'guide de bonnes pratiques': OncoDoc, un systeme d'aide a la decision therapeutique applique au cancer du sein AUTHOR NAMES Bouaud J. Séroussi B. Antoine E.-C. Gozy M. Khayat D. Boisvieux J.-F. AUTHOR ADDRESSES (Bouaud J.; Séroussi B.; Boisvieux J.-F.) Serv. d'Informatique Médicale, AP-HP and Dept. de Biomathematiques, Université Paris 6, 91 boulevard de l'Hôpital, 75634 Paris Cedex 13, France. (Antoine E.-C.; Gozy M.; Khayat D.) Service d'Oncologie Médicale, Grp. Hosp. Pitie-Salpetriere, 47-81, boulevard de l'Hôpital, 75651 Paris Cedex 13, France. CORRESPONDENCE ADDRESS J. Bouaud, Service d'Informatique Medicale, AP-HP, Universite Paris 6, 91 boulevard de l'Hopital, 75634 Paris Cedex 13, France. SOURCE Therapie (1999) 54:2 (209-215). Date of Publication: 1999 ISSN 0040-5957 BOOK PUBLISHER EDP Sciences, 17 Avenue du Hoggar - BP 112, Les Ulis Cedex A, France. ABSTRACT Beyond considerations of cost-effectiveness, clinical practice guidelines (CPG) can reduce practice variations and thus improve the quality of care. However, despite the proliferation of implemented CPG and their wide diffusion thanks to Internet-based technologies, physicians' compliance with formal standards is weak. Developed according to a document-based paradigm, OncoDoc proposes original framework for implementing CPG. Domain knowledge has been encoded as a decision tree whose branches are both exclusive and exhaustive. This generic knowledge is operationalized at the point of care by the interactive building, through hypertextual navigation, of a patient-based clinical context leading to specific therapeutic recommendations. OncoDoc has first been applied to the management of breast cancer patients and demonstrated within a full-scale experimentation in a clinical setting a compliance of 80 per cent. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (disease management) medical decision making practice guideline EMTREE MEDICAL INDEX TERMS article clinical practice consultation patient priority journal EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1999193418 MEDLINE PMID 10394256 (http://www.ncbi.nlm.nih.gov/pubmed/10394256) PUI L29255591 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 518 TITLE Is axillary lymph node dissection indicated for early-stage breast cancer? A decision analysis AUTHOR NAMES Parmigiani G. Berry D.A. Winer E.P. Tebaldi C. Iglehart J.D. Prosnitz L.R. AUTHOR ADDRESSES (Parmigiani G., gp@isds.duke.edu) Inst. of Stat. and Decision Sciences, Box 90251, Duke University, Durham, NC 27708, United States. (Berry D.A.; Winer E.P.; Tebaldi C.; Iglehart J.D.; Prosnitz L.R.) CORRESPONDENCE ADDRESS G. Parmigiani, Inst. of Statistics/Decision Sci., Box 90251, Duke University, Durham, NC 27708, United States. Email: gp@isds.duke.edu SOURCE Journal of Clinical Oncology (1999) 17:5 (1465-1473). Date of Publication: May 1999 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Axillary lymph node dissection (ALND) has been a standard procedure in the management of breast cancer. In a patient with a clinically negative axilla, ALND is performed primarily for staging purposes, to guide adjuvant treatment. Recently, the routine use of ALND has been questioned because the results of the procedure may not change the choice of adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the benefits of ALND for patients eligible for breast-conserving therapy. Methods: Patients were grouped by age, tumor size, and estrogen receptor (ER) status. The model uses the Oxford overviews and three combined Cancer and Leukemia Group B studies. We assumed that patients who did not undergo ALND received axillary radiation therapy and that the two procedures are equally effective. All chemotherapy combinations were assumed to be equally efficacious. Results: The largest benefits from ALND are seen in ER-positive women with small primary tumors who might not be candidates for adjuvant chemotherapy if their lymph nodes test negative. Virtually no benefit results in ER-negative women, almost all of whom would receive adjuvant chemotherapy. When adjusted for quality of life (QOL), ALND may have an overall negative impact. In general, the benefits of ALND increase with the expected severity of adjuvant therapy on QOL. Conclusion: Our model quantifies the benefits of ALND and assists decision making by patients and physicians. The results suggest that the routine use of ALND in breast cancer patients should be reassessed and may not be necessary in many patients. EMTREE DRUG INDEX TERMS tamoxifen (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) lymph node dissection EMTREE MEDICAL INDEX TERMS adult age article axillary lymph node cancer size cancer survival combination chemotherapy decision making female human life expectancy partial mastectomy priority journal quality adjusted life year treatment planning CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999167381 MEDLINE PMID 10334532 (http://www.ncbi.nlm.nih.gov/pubmed/10334532) PUI L29220853 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 519 TITLE Breast restoration decision making. AUTHOR NAMES Reaby L.L. AUTHOR ADDRESSES (Reaby L.L.) School of Nursing, Faculty of Applied Science, University of Canberra, Australia. CORRESPONDENCE ADDRESS L.L. Reaby, School of Nursing, Faculty of Applied Science, University of Canberra, Australia. SOURCE Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses (1999) 19:1 (22-29). Date of Publication: 1999 Spring ISSN 0741-5206 ABSTRACT Women diagnosed with breast cancer have many physiological and psychological adjustments to make following mastectomy. The present study described in this article sought to determine the decision-making patterns used by two groups of women. Nurses need to be well informed and professionally confident to provide the individualized care and support deserved by women throughout the breast cancer trajectory. A major outcome of such professional care is confident women who understand their disease, treatments, and methods to manage stresses as they occur. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (surgery) decision making mastectomy (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged article decision support system female human methodology middle aged nursing nursing methodology research patient education psychological aspect psychological model questionnaire social support LANGUAGE OF ARTICLE English MEDLINE PMID 10478127 (http://www.ncbi.nlm.nih.gov/pubmed/10478127) PUI L31401128 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 520 TITLE Analysis of three decision-making methods: A breast cancer patient as a model AUTHOR NAMES Carter K.J. Ritchey N.P. Castro F. Caccamo L.P. Kessler E. Erickson B.A. AUTHOR ADDRESSES (Carter K.J.) St. Elizabeth Health Center, 1044 Belmont Avenue, Youngstown, OH 44501-1790, United States. (Ritchey N.P.; Castro F.; Caccamo L.P.; Kessler E.; Erickson B.A.) CORRESPONDENCE ADDRESS K.J. Carter, St. Elizabeth Health Center, 1044 Belmont Avenue, Youngstown, OH 44501-1790, United States. SOURCE Medical Decision Making (1999) 19:1 (49-57). Date of Publication: January/March 1999 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Purpose: To compare three decision making techniques using a common clinical problem. Methods: Two recently developed methods, the analytic hierarchy process (AHP) and the analytic network process (ANP), were compared with a Markov process in the evaluation of the optimal post-lumpectomy treatment strategy for an elderly woman with a mammographically detected, nonpalpable early-stage breast cancer. The following treatment alternatives were considered: observation, radiation, tamoxifen, combination radiation and tamoxifen, and simple mastectomy. All three decision methods incorporated patient preferences. Results: The models agreed on the ranking of the preferred treatment, radiation and tamoxifen, but there were variations in the rankings of the other treatment choices. Individual differences between the three models were uncovered. The Markov process provided estimates of quality-adjusted life expectancy and distribution of health events. Both AHP and ANP required less development time than the Markov process. Conclusion: All three methods may be useful tools to the clinician in analyzing complex medical problems. The Markov is the most labor-intensive method but provides detailed results, whereas the AHP and the ANP give only rank orders of the alternatives. The most important considerations in choosing between these methods are time to project completion and the detail of information sought. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS aged article cancer chemotherapy cancer radiotherapy cancer surgery case report female human mathematical analysis medical decision making partial mastectomy quality adjusted life year statistical analysis CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999025151 MEDLINE PMID 9917020 (http://www.ncbi.nlm.nih.gov/pubmed/9917020) PUI L29031794 DOI 10.1177/0272989X9901900107 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X9901900107 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 521 TITLE Using an interactive video disk in breast cancer patient support. AUTHOR NAMES Maslin A.M. Baum M. Walker J.S. A'Hern R. Prouse A. AUTHOR ADDRESSES (Maslin A.M.; Baum M.; Walker J.S.; A'Hern R.; Prouse A.) Department of Health, London. CORRESPONDENCE ADDRESS A.M. Maslin, Department of Health, London. SOURCE Nursing times (1998) 94:44 (52-55). Date of Publication: 1998 Nov 4-10 ISSN 0954-7762 ABSTRACT A randomised-controlled trial compared outcomes for women recently diagnosed with breast cancer who either received support and information from a multidisciplinary team or used a shared decision-making programme on an interactive video disk (IVD) system. Using the IVD did not have a significant effect on the decisions women made about treatment, yet it was evaluated positively by those who used it. The results suggest that the role of clinical staff is more significant than the form of information provided. Potential benefits for the IVD were apparent such as standardising the information received by patients, promoting evidence-based practice and providing a measure for quality assurance. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) computer interface decision support system patient education teaching videorecording EMTREE MEDICAL INDEX TERMS adult aged article clinical trial comparative study controlled clinical trial controlled study female health status human methodology middle aged patient care psychological aspect randomized controlled trial LANGUAGE OF ARTICLE English MEDLINE PMID 9919256 (http://www.ncbi.nlm.nih.gov/pubmed/9919256) PUI L129386184 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 522 TITLE Testing for the BRCA1 and BRCA2 breast-ovarian cancer susceptibility genes: A decision analysis AUTHOR NAMES Tengs T.O. Winer E.P. Paddock S. Aguilar-Chavez O. Berry D.A. AUTHOR ADDRESSES (Tengs T.O., tengs@uci.edu) Department of Urban and Regional Planning, School of Social Ecology, University of California, Irvine, Irvine, CA 92697-7075, United States. (Winer E.P.; Paddock S.; Aguilar-Chavez O.; Berry D.A.) CORRESPONDENCE ADDRESS T.O. Tengs, Dept. of Urban and Regional Planning, School of Social Ecology, University of California, Irvine, CA 92697-7075, United States. Email: tengs@uci.edu SOURCE Medical Decision Making (1998) 18:4 (365-375). Date of Publication: 1998 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Objective. The authors developed a Markov decision model to evaluate the health implications of testing for mutations in the BRCA1 and BRCA2 breast- ovarian cancer susceptibility genes. Prophylactic measures considered included various combinations of immediate and delayed bilateral mastectomy and oophorectomy or taking no action. Methods. The model incorporated the likelihood of developing breast and/or ovarian cancer, survival, and quality of life. Parameter values were taken from public databases, the published literature, and a survey of cancer experts. Outcomes considered were additional life expectancy and quality-adjusted life years (QALYs). Results are reported for 30-year-old cancer-free women at various levels of hereditary risk. Results and conclusions. The vast majority of women will not benefit from testing because their pre-test risks are low and surgical prophylaxis is undesirable. However, women who have family histories of early breast and/or ovarian cancer may gain up to 2 QALYs by allowing genetic testing to inform their decisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer susceptibility ovary cancer (surgery) tumor suppressor gene EMTREE MEDICAL INDEX TERMS adult article cancer risk cancer survival case report family history female gene mutation human life expectancy mastectomy medical decision making ovariectomy quality adjusted life year EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998342739 MEDLINE PMID 10372578 (http://www.ncbi.nlm.nih.gov/pubmed/10372578) PUI L28465276 DOI 10.1177/0272989X9801800402 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X9801800402 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 523 TITLE Profiles of distress in women following treatment for primary breast cancer AUTHOR NAMES Dunn J. Steginga S.K. Occhipinti S. Wilson K. McCaffrey J. AUTHOR ADDRESSES (Dunn J.; Steginga S.K.; McCaffrey J.) Queensland Cancer Fund, Spring Hill, QLD, Australia. (Occhipinti S.) Australian Catholic University, Mitchelton, QLD, Australia. (Wilson K.) Griffith University, Mt Gravatt, QLD, Australia. (Dunn J.) Community Services, Queensland Cancer Fund, PO Box 201, Spring Hill, QLD 4004, Australia. CORRESPONDENCE ADDRESS J. Dunn, Director of Community Services, Queensland Cancer Fund, PO Box 201, Spring Hill, QLD 4004, Australia. SOURCE Breast (1998) 7:5 (251-254). Date of Publication: Oct 1998 ISSN 0960-9776 ABSTRACT The present study describes the difficulties experienced by women after surgery for breast cancer and identifies key issues. A sample of 245 women not more than 16 weeks post-surgery for breast cancer completed the Experience of Breast Cancer Questionnaire and the Psychological subscale of the Rotterdam Symptom Checklist. Of the total group, 67% of women were anxious or depressed. Women who had a mastectomy experienced more difficulties with self-image whereas women who had breast conservation reported more problems with inadequate informational support and decisional uncertainty or regret (P < 0.0001). The reporting of difficult psychological and physical symptoms and inadequate informational support and decisional uncertainty was related to women's anxiety and depression (P < 0.0001). The profile of difficulties experienced by women after breast cancer varies according to the type of surgical treatment. Therefore, the support offered to women by clinicians both pre- and post-surgery should be tailored to address the concerns characteristic of each treatment type. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) distress syndrome (diagnosis) EMTREE MEDICAL INDEX TERMS adult anxiety anxiety neurosis (diagnosis) article depression (diagnosis) female human major clinical study mastectomy medical information priority journal psychologic assessment questionnaire self concept social support EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998377844 PUI L28510734 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 524 TITLE Patient-provider decisions about long-term therapy AUTHOR NAMES Seely E.W. Ravnikar V.A. McClung B.L. AUTHOR ADDRESSES (Seely E.W.; Ravnikar V.A.; McClung B.L.) SOURCE American Journal of Managed Care (1998) 4:2 SUPPL. (S70-S76). Date of Publication: 1998 ISSN 1088-0224 ABSTRACT Quality-of-life issues, patient adherence, and effective patient- provider communication play key roles in the success of any long-term therapy, but especially in the prevention or treatment of a condition such as osteoporosis, which is often asymptomatic. Quality of life is a multifaceted concept comprising general well-being and life satisfaction, physical and emotional states, intellectual functioning, and work performance/social functioning. Assessing patients' quality of life at baseline through the use of a questionnaire, interview, and physical examination suggests that manner in which long-term therapy will affect their adherence to therapy and future well-being. In osteoporosis prevention, a decision-making analysis and bone mineral density (BMD) measurement may enhance patient adherence, which is particularly challenging with hormone replacement therapy (HRT). Healthcare providers should also consider flexibility in dosing. Two major obstacles to persistence with HRT are uterine bleeding and fear of developing breast cancer. When addressing concerns about the possible link between HRT and breast cancer, the care provider should clarify the meaning of disease incidence, absolute risk, and relative risk data. A model of effective patient-provider communication used by the osteoporosis prevention program at the Oregon Osteoporosis Center is presented. Using a team approach, the program assesses patients' risk for osteoporosis, recommends individual strategies for preventing bone loss, and provides education and counseling during the first visit and follow-up visits to improve adherence. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) long term care osteoporosis (diagnosis, prevention, therapy) EMTREE MEDICAL INDEX TERMS bone density bone mineral breast cancer (complication) conference paper dose response follow up health program hormonal therapy job performance life satisfaction medical decision making patient care patient compliance patient counseling priority journal quality of life risk factor social status uterus bleeding (complication) EMBASE CLASSIFICATIONS Endocrinology (3) Orthopedic Surgery (33) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998252373 PUI L28347539 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 525 TITLE Assessment of the time-tradeoff values for prophylactic mastectomy of women with a suspected genetic predisposition to breast cancer AUTHOR NAMES Unic I. Stalmeier P.F.M. Verhoef L.C.G. Van Daal W.A.J. AUTHOR ADDRESSES (Unic I.) Institute for Radiotherapy, Radboud University Hospital, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. (Stalmeier P.F.M.; Verhoef L.C.G.; Van Daal W.A.J.) CORRESPONDENCE ADDRESS I. Unic, Institute for Radiotherapy, Radboud University Hospital, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. SOURCE Medical Decision Making (1998) 18:3 (268-277). Date of Publication: 1998 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background. Female carriers of the breast-cancer-susceptibility genes BRCA1 and BRCA2 are at high risk for breast cancer (85%). They face the choice between prophylactic mastectomy (PM) and breast cancer screening. For this treatment choice, a shared-decision-making program was developed. In this program, the time tradeoff (TTO) was used to assess preferences for PM. Purpose. Assessment of the feasibility, constant proportional tradeoff, and reliability of using the TTO for this purpose. Methods. Fifty-four women suspected to carry the BRCA1/2 mutation were provided with comprehensive relevant information. Their preferences for PM were assessed on two occasions. Discrepancies between preferences indicated by the two tests were resolved by testing a third time. The preferences assessed on the last occasion were used for individual decision analyses. In order to test constant proportional tradeoff, the TTO consisted of four items with different numbers of life years. Results. Forty-two women (78%) completed the TTO twice and nine women (17%) performed the test a third time. Three women (5%) completed the TTO only once. The mean TTO value for PM at the last replication was 0.69 (SD = 0.30). Violations of constant proportional tradeoff were significant: the largest tradeoffs were recorded for the shortest durations. Pearson's correlation coefficient between the TTO values for the two last sessions was 0.96. Conclusion. Assessment of individual preferences by the TTO in this patient group is feasible and reliable. Therefore, the TTO can be used in clinical settings to elicit treatment preferences of women proven or suspected to have a genetic predisposition to breast cancer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (congenital disorder, surgery) genetic predisposition mastectomy medical decision making EMTREE MEDICAL INDEX TERMS adult aged article cancer screening decision making female heterozygote human major clinical study statistical analysis treatment planning EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998223910 MEDLINE PMID 9679991 (http://www.ncbi.nlm.nih.gov/pubmed/9679991) PUI L28307556 DOI 10.1177/0272989X9801800303 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X9801800303 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 526 TITLE Domains of distress: the experience of breast cancer in Australia. AUTHOR NAMES Steginga S. Occhipinti S. Wilson K. Dunn J. AUTHOR ADDRESSES (Steginga S.; Occhipinti S.; Wilson K.; Dunn J.) Australian Catholic University in Brisbane, Queensland, Australia. CORRESPONDENCE ADDRESS S. Steginga, Australian Catholic University in Brisbane, Queensland, Australia. SOURCE Oncology nursing forum (1998) 25:6 (1063-1070). Date of Publication: Jul 1998 ISSN 0190-535X ABSTRACT PURPOSE/OBJECTIVES: To describe difficulties experienced by women after treatment for primary breast cancer. DESIGN: Descriptive and exploratory. SETTING: Queensland, Australia. SAMPLE: 245 women (70% response rate) less than 16 weeks postsurgery for breast cancer completed a survey. The mean age for this sample was 55 years; 71% had undergone mastectomy, and 29% had undergone conservative breast surgery. METHODS: Focus groups were used to generate items for the survey, "Experience of Breast Cancer Questionnaire" (EBCQ). The EBCQ and the psychological subscale of the Rotterdam Symptom Checklist (RSCL) were administered by mail to the sample. MAIN RESEARCH VARIABLES: Psychological distress, fear of recurrence, decisional uncertainty, informational support, self-image and social relationships, sexual morbidity, and physical effects of treatments. FINDINGS: Factor analysis of the EBCQ identified five factors, accounting for 60% of the variance. These included psychological effects, treatment concerns, physical effects, self-image, and chemotherapy effects. Four of the five subscales had reliability coefficients of greater than 0.80. Psychological effects included cognitive and emotional effects. Treatment concerns included decisional uncertainty and poorly perceived informational support. Physical effects reflected the symptom pattern of axillary dissection. Self-image included breast loss and social isolation. CONCLUSIONS: Nurses who assist women in adjusting to breast cancer should consider the effect of fear of recurrence and perceptions of body image on the recovery process. Because participation in treatment decisions may increase the demands on women at diagnosis, informational support appropriate to each woman's needs is essential. How self-esteem can affect self-image and social relationships after breast cancer requires further investigation. IMPLICATIONS FOR NURSING PRACTICE: Understanding the experience of illness from the perspective of the patient assists nurses in validating their nursing practice and provides clinically relevant information to guide intervention. In particular, supportive psychological care should target both emotional and cognitive responses to breast cancer. Informational support is integral to a patient's satisfaction with treatment decisions and is likely to predict adjustment. When assisting women to adjust to self-image changes, nurses may need to target women's perceptions about their body image. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) questionnaire EMTREE MEDICAL INDEX TERMS article body image fear female human information processing libido mastectomy mental stress middle aged nursing oncology nursing postoperative complication psychological aspect psychometry social support tumor recurrence LANGUAGE OF ARTICLE English MEDLINE PMID 9679264 (http://www.ncbi.nlm.nih.gov/pubmed/9679264) PUI L128291874 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 527 TITLE Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1- positive or BRCA2-positive patients AUTHOR NAMES Grann V.R. Panageas K.S. Whang W. Antman K.H. Neugut A.I. AUTHOR ADDRESSES (Grann V.R., VRG2@columbia.edu) Herbert Irving Compreh. Cancer Ctr., College of Physicians and Surgeons, PH18-201A, 630 West 168th St, New York, NY 10032, United States. (Panageas K.S.; Whang W.; Antman K.H.; Neugut A.I.) CORRESPONDENCE ADDRESS V.R. Grann, H. Irving Comprehensive Cancer Ctr., College of Physicians and Surgeons, PH18-201A, 630 West 168th St, New York, NY 10032, United States. Email: VRG2@columbia.edu SOURCE Journal of Clinical Oncology (1998) 16:3 (979-985). Date of Publication: March 1998 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: Young Ashkenazi Jewish women or those from high-risk families who test positive for BRCA1 or BRCA2 mutant genes have a significant risk of developing breast or ovarian cancer by the age of 70 years. Many question whether they should have prophylactic surgical procedures, ie, bilateral mastectomy and/or oophorectomy. Methods: A Markov model was developed to determine the survival, quality of life, and cost-effectiveness of prophylactic surgical procedures. The probabilities of developing breast and ovarian cancer were based on literature review among women with the BRCA1 or BRCA2 gene and mortality rates were determined from Surveillance, Epidemiology, and End Results (SEER) data for 1973 to 1992. The costs for hospital and ambulatory care were estimated from Health Care Financing Administration (HCFA) payments in 1995, supplemented by managed care and fee- for-service data. Utility measures for quality-adjusted life-years (QALYs) were explicity determined using the time-trade off method. Estimated risks for breast and ovarian cancer after prophylactic surgeries were obtained from the literature. Results: For a 30-year-old woman, according to her cancer risks, prophylactic oophorectomy improved survival by 0.4 to 2.6 years; mastectomy, by 2.8 to 3.4 years; and mastectomy and oophorectomy, by 3.3 to 6.0 years over surveillance. The QALYs saved were 0.5 for oophorectomy and 1.9 for the combined procedures in the high-risk model. Prophylactic surgeries were cost-effective compared with surveillance for years of life saved, but not for QALYs. Conclusion: Among women who test positive for o BRCA1 or BRCA2 gene mutation, prophylactic surgery at a young age substantially improves survival, but unless genetic risk of cancer is high, provides no benefit for quality of life. Prophylactic surgery is cost- effective for years of life saved compared with other medical interventions that are deemed cost-effective. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer risk mastectomy ovariectomy ovary cancer EMTREE MEDICAL INDEX TERMS article cancer prevention cancer survival cost benefit analysis gene mutation genetic risk model priority journal quality of life risk assessment EMBASE CLASSIFICATIONS Cancer (16) Human Genetics (22) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998077108 MEDLINE PMID 9508180 (http://www.ncbi.nlm.nih.gov/pubmed/9508180) PUI L28108730 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 528 TITLE Axillary lymph node dissection for breast cancer: A decision analysis of T1 lesions AUTHOR NAMES Velanovich V. AUTHOR ADDRESSES (Velanovich V.) Division of General Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI, United States. (Velanovich V.) Division of General Surgery, K-8, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202-2689, United States. CORRESPONDENCE ADDRESS V. Velanovich, Division of General Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202-2689, United States. SOURCE Annals of Surgical Oncology (1998) 5:2 (131-139). Date of Publication: March 1998 ISSN 1068-9265 BOOK PUBLISHER Springer New York LLC, 233 Springer Street, New York, United States. ABSTRACT Background: The value of routine axillary dissection for patients with breast cancer is still being debated. The argument centers around whether the information gained by knowing the lymph node status, which aids in making the decision about adjuvant chemotherapy, justifies the morbidity. This study quantitatively analyzes the potential outcomes of routine, selective, and no axillary dissection. Methods: A decision analysis was performed of the strategies of lumpectomy and radiation versus simple mastectomy followed by no dissection, selective dissection, or routine dissection. Factors included biologic markers to identify high-risk lesions, the morbidity of axillary dissection, the effects of adjuvant chemotherapy on lymph node-negative and lymph node-positive disease, and the life expectancy of patients with high- risk and low-risk node-negative and node-positive lesions. Sensitivity analysis was done to determine threshold levels of these factors in choosing an option. Results: We discovered an advantage in quality-adjusted life expectancy (QALE) for no axillary dissection until the probability of positive lymph nodes reaches >15%; after that, selective node dissection is superior. Selective dissection is superior for lower morbidity rates of axillary dissection. Routine dissection is never a superior strategy. The difference among these strategies is small, however, with no one strategy providing a QALE greater than I year longer than any other. Conclusions: Axillary dissection can be avoided in patients with high-risk lesions who would be candidates for adjuvant chemotherapy regardless of lymph node status, and possibly in patients with low-risk T1a lesions, but it should be recommended for low-risk T1b and T1c lesions for which lymph node status may determine the need for adjuvant chemotherapy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, surgery, therapy) lymph node metastasis (complication, diagnosis, surgery, therapy) EMTREE MEDICAL INDEX TERMS article axillary lymph node cancer adjuvant therapy cancer staging human life expectancy lymph node dissection medical decision making prognosis quality adjusted life year treatment indication EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999055182 MEDLINE PMID 9527266 (http://www.ncbi.nlm.nih.gov/pubmed/9527266) PUI L29071282 DOI 10.1007/BF02303846 FULL TEXT LINK http://dx.doi.org/10.1007/BF02303846 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 529 TITLE BRCA1: to test or not to test, that is the question. AUTHOR NAMES Singer M.E. Cebul R.D. AUTHOR ADDRESSES (Singer M.E.; Cebul R.D.) School of Medicine, Case Western Reserve University, USA. CORRESPONDENCE ADDRESS M.E. Singer, School of Medicine, Case Western Reserve University, USA. SOURCE Health matrix (Cleveland, Ohio : 1991) (1997) 7:1 (163-185). Date of Publication: 1997 Winter ISSN 0748-383X EMTREE DRUG INDEX TERMS antineoplastic hormone agonists and antagonists (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention, therapy) genetic screening patient participation tumor suppressor gene EMTREE MEDICAL INDEX TERMS adult article decision support system economics female genetics Genetics and Reproduction health insurance human Jew mastectomy psychological aspect risk factor social psychology uncertainty United States CAS REGISTRY NUMBERS tamoxifen (10540-29-1) LANGUAGE OF ARTICLE English MEDLINE PMID 10167173 (http://www.ncbi.nlm.nih.gov/pubmed/10167173) PUI L127265651 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 530 TITLE The role of histologic grading in the prognosis of patients with carcinoma of the breast: Is this a neglected opportunity? AUTHOR NAMES Roberti N.E. AUTHOR ADDRESSES (Roberti N.E.) 58 St. Malo Beach, Oceanside, CA 92054, United States. CORRESPONDENCE ADDRESS N.E. Roberti, 58 St. Malo Beach, Oceanside, CA 92054, United States. SOURCE Cancer (1997) 80:9 (1708-1716). Date of Publication: 1 Nov 1997 ISSN 0008-543X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND. Quantified grading of breast carcinoma through histologic analysis has been practiced for many years, but generally has not been used as an aid in treatment decision-making. METHODS. A representative sample of the literature is reviewed and discussed. RESULTS. The literature overwhelmingly confirms that histologic features suitable for grading provide important prognostic information at all stages of the disease, but there is no uniformly agreed on methodology for the application of this information. Disagreement still exists as to its validity and it is often ignored. CONCLUSIONS. It appears reasonable that serious attempts be made to overcome the perceived problems with the grading of breast carcinoma and to develop a consensus regarding a methodology for quantifying this well established index of the virulence of the disease that is comparable to the consensus reached in the American Joint Committee on Cancer staging of the extent of disease. This information then could be used in the design of clinical trials. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (clinical trial, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (drug therapy, radiotherapy, surgery) cancer grading EMTREE MEDICAL INDEX TERMS axillary lymph node cancer chemotherapy cancer radiotherapy cancer recurrence cancer staging cancer survival clinical trial female histopathology human lymph node dissection methodology partial mastectomy priority journal prognosis review EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cancer (16) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997343339 MEDLINE PMID 9351538 (http://www.ncbi.nlm.nih.gov/pubmed/9351538) PUI L27475927 DOI 10.1002/(SICI)1097-0142(19971101)80:9<1708::AID-CNCR3>3.0.CO;2-A FULL TEXT LINK http://dx.doi.org/10.1002/(SICI)1097-0142(19971101)80:9<1708::AID-CNCR3>3.0.CO;2-A COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 531 TITLE Risk of breast cancer in carriers of BRCA gene mutations. AUTHOR NAMES Meijer W.J. van Lindert A.C. AUTHOR ADDRESSES (Meijer W.J.; van Lindert A.C.) CORRESPONDENCE ADDRESS W.J. Meijer, SOURCE The New England journal of medicine (1997) 337:11 (788; author reply 789). Date of Publication: 11 Sep 1997 ISSN 0028-4793 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention) ovariectomy EMTREE MEDICAL INDEX TERMS decision support system female human life expectancy mastectomy note risk theoretical model LANGUAGE OF ARTICLE English MEDLINE PMID 9289640 (http://www.ncbi.nlm.nih.gov/pubmed/9289640) PUI L127290930 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 532 TITLE Risk of breast cancer in carriers of BRCA gene mutations. AUTHOR NAMES Orlando 3rd. R. AUTHOR ADDRESSES (Orlando 3rd. R.) CORRESPONDENCE ADDRESS R. Orlando, SOURCE The New England journal of medicine (1997) 337:11 (787; author reply 789). Date of Publication: 11 Sep 1997 ISSN 0028-4793 EMTREE DRUG INDEX TERMS BRCA2 protein transcription factor tumor protein EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention) decision support system ovary tumor (prevention) EMTREE MEDICAL INDEX TERMS female genetics human life expectancy mastectomy mutation note ovariectomy tumor suppressor gene LANGUAGE OF ARTICLE English MEDLINE PMID 9289637 (http://www.ncbi.nlm.nih.gov/pubmed/9289637) PUI L127836726 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 533 TITLE Risk of breast cancer in carriers of BRCA gene mutations. AUTHOR NAMES Birkmeyer J.D. Welch H.G. AUTHOR ADDRESSES (Birkmeyer J.D.; Welch H.G.) CORRESPONDENCE ADDRESS J.D. Birkmeyer, SOURCE The New England journal of medicine (1997) 337:11 (787-788; author reply 789). Date of Publication: 11 Sep 1997 ISSN 0028-4793 EMTREE DRUG INDEX TERMS BRCA2 protein transcription factor tumor protein EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (prevention) life expectancy ovary tumor (prevention) EMTREE MEDICAL INDEX TERMS decision support system female genetics human mastectomy mutation note ovariectomy tumor suppressor gene LANGUAGE OF ARTICLE English MEDLINE PMID 9289638 (http://www.ncbi.nlm.nih.gov/pubmed/9289638) PUI L127836727 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 534 TITLE Patient participation and decision control: are patient autonomy and well-being associated? AUTHOR NAMES de Haes H.C. Molenaar S. AUTHOR ADDRESSES (de Haes H.C.; Molenaar S.) CORRESPONDENCE ADDRESS H.C. de Haes, SOURCE Medical decision making : an international journal of the Society for Medical Decision Making (1997) 17:3 (353-354). Date of Publication: 1997 Jul-Sep ISSN 0272-989X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision support system patient participation patient satisfaction quality of life EMTREE MEDICAL INDEX TERMS breast tumor (surgery) control female human note partial mastectomy psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 9219198 (http://www.ncbi.nlm.nih.gov/pubmed/9219198) PUI L127283778 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 535 TITLE Decision analysis - Effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations AUTHOR NAMES Schrag D. Kuntz K.M. Garber J.E. Weeks J.C. AUTHOR ADDRESSES (Schrag D.; Weeks J.C.) Ctr. for Outcomes and Plcy. Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, United States. (Garber J.E.) Division of Cancer Epidemiology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, United States. (Kuntz K.M.) Section for Clinical Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, United States. (Weeks J.C.) Ctr. for Outcomes and Plcy. Research, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115, United States. CORRESPONDENCE ADDRESS J.C. Weeks, Center for Outcomes/Policy Research, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115, United States. SOURCE New England Journal of Medicine (1997) 336:20 (1465-1471). Date of Publication: 1997 ISSN 0028-4793 BOOK PUBLISHER Massachussetts Medical Society, 860 Winter Street, Waltham, United States. ABSTRACT Background: Women with BRCA1 or BRCA2 mutations have an increased risk of breast cancer and ovarian cancer. Prophylactic mastectomy and oophorectomy are often considered as ways of reducing these risks, but the effect of the procedures on life expectancy has not been established. Methods: In a decision analysis, we compared prophylactic mastectomy and prophylactic oophorectomy with no prophylactic surgery among women who carry mutations in the BRCA1 or BRCA2 gene. We used available data about the incidence of cancer, the prognosis for women with cancer, and the efficacy of prophylactic mastectomy and oophorectomy in preventing breast and ovarian cancer to estimate the effects of these interventions on life expectancy among women with different levels of risk of cancer. Results: We calculated that, on average, 30-year-old women who carry BRCA1 or BRCA2 mutations gain from 2.9 to 5.3 years of life expectancy from prophylactic mastectomy and from 0.3 to 1.7 years of life expectancy from prophylactic oophorectomy, depending on their cumulative risk of cancer. Gains in life expectancy decline with age at the time of prophylactic surgery and are minimal for 60-year-old women. Among 30-year-old women, oophorectomy may be delayed 10 years with little loss of life expectancy. Conclusions: On the basis of a range of estimates of the incidence of cancer, prognosis, and efficacy of prophylactic surgery, our model suggests that prophylactic mastectomy provides substantial gains in life expectancy and prophylactic oophorectomy more limited gains for young women with BRCA1 or BRCA2 mutations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer susceptibility gene mutation mastectomy ovariectomy EMTREE MEDICAL INDEX TERMS article cancer recurrence cancer risk cancer survival carcinogenesis medical decision making model priority journal prophylaxis risk assessment EMBASE CLASSIFICATIONS Internal Medicine (6) Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997148070 MEDLINE PMID 9148160 (http://www.ncbi.nlm.nih.gov/pubmed/9148160) PUI L27208615 DOI 10.1056/NEJM199705153362022 FULL TEXT LINK http://dx.doi.org/10.1056/NEJM199705153362022 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 536 TITLE Factors that influence plastic surgeons' advice about reconstruction to women with breast cancer. AUTHOR NAMES Neill K.M. Briefs B.A. AUTHOR ADDRESSES (Neill K.M.; Briefs B.A.) School of Nursing, Georgetown University Medical Center, Washington, DC, USA. CORRESPONDENCE ADDRESS K.M. Neill, School of Nursing, Georgetown University Medical Center, Washington, DC, USA. SOURCE Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses (1997) 17:2 (61-67). Date of Publication: 1997 Summer ISSN 0741-5206 ABSTRACT The purpose of this pilot study was to describe the factors that influence the advice of plastic surgeons who offer reconstructive surgery to women with breast cancer. Answers to the following question were sought: What anatomical, technical, and personal factors are considered by plastic surgeons in their recommendations for reconstruction to women with breast cancer? Five themes emerged that explained approaches used with these patients: (1) technical issues and challenges, (2) patient-centered challenges, (3) aids to patient decision-making, (4) illusion of no loss, and (5) age. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction health personnel attitude patient education patient selection physician EMTREE MEDICAL INDEX TERMS article breast tumor (surgery) female human male methodology nursing methodology research pilot study psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 9275783 (http://www.ncbi.nlm.nih.gov/pubmed/9275783) PUI L127305308 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 537 TITLE Patient-specific decisions about hormone replacement therapy in postmenopausal women AUTHOR NAMES Col N.F. Eckman M.H. Karas R.H. Pauker S.G. Goldberg R.J. Ross E.M. Orr R.K. Wong J.B. AUTHOR ADDRESSES (Col N.F., nananda.col@es.nemc.org; Eckman M.H.; Pauker S.G.; Ross E.M.; Wong J.B.) Div. Clin. Decis. Making, Info., T., Department of Medicine, Tufts University School of Medicine, Boston, MA, United States. (Karas R.H.) Division of Cardiology, Department of Medicine, Tufts University School of Medicine, Boston, MA, United States. (Goldberg R.J.; Orr R.K.) Univ. of Massachusetts Med. Center, Worcester, MA, United States. (Orr R.K.) Fallon Health Care System, Worcester, MA, United States. (Col N.F., nananda.col@es.nemc.org) New England Medical Center, Div. Clin. Decis. Making, Info., T., Box 302, 750 Washington St, Boston, MA 02111, United States. CORRESPONDENCE ADDRESS N.F. Col, DCDMIT, New England Medical Center, Box 302, 750 Washington St, Boston, MA 02111, United States. SOURCE Journal of the American Medical Association (1997) 277:14 (1140-1147). Date of Publication: 9 Apr 1997 ISSN 0098-7484 BOOK PUBLISHER American Medical Association, 515 North State Street, Chicago, United States. ABSTRACT Objective.-To examine the effect of hormone replacement therapy on life expectancy in postmenopausal women with different risk profiles for heart disease, breast cancer, and hip fracture. Design.-Decision analysis using a Markov model. Published regression models were used to link risk factors to disease incidence and to estimate the lifetime risks of developing coronary heart disease (CHD), breast cancer, hip fracture, and endometrial cancer. The impact of hormone therapy on disease incidence was estimated from published epidemiologic studies. Setting.-Mathematical model applicable to primary care. Interventions.-Treatment with hormone replacement therapy or no hormone replacement therapy. Main Outcome Measure.-Life expectancy. Results.-Hormone replacement therapy should increase life expectancy for nearly all postmenopausal women, with some gains exceeding 3 years, depending mainly on an individual's risk factors for CHD and breast cancer. For women with at least 1 risk factor for CHD, hormone therapy should extend life expectancy, even for women having first-degree relatives with breast cancer. Women without any risk factors for CHD or hip fracture, but who have 2 first- degree relatives with breast cancer, however, should not receive hormone therapy. Conclusions.-The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the risk of breast cancer for nearly all women in whom this treatment might be considered. Our analysis supports the broader use of hormone replacement therapy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) conjugated estrogen estrogen gestagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hormone substitution postmenopause EMTREE MEDICAL INDEX TERMS adult aged article breast cancer endometrium cancer female hip fracture human incidence ischemic heart disease life expectancy major clinical study medical decision making priority journal risk factor EMBASE CLASSIFICATIONS Endocrinology (3) Obstetrics and Gynecology (10) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997110812 MEDLINE PMID 9087469 (http://www.ncbi.nlm.nih.gov/pubmed/9087469) PUI L27157632 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 538 TITLE Physicians' opinions about decision aids for patients considering systemic adjuvant therapy for axillary-node negative breast cancer AUTHOR NAMES O'Connor A.M. Llewellyn-Thomas H.A. Sawka C. Pinfold S.P. To T. Harrison D.E. AUTHOR ADDRESSES (O'Connor A.M.) Clinical Epidemiology Unit, Ottawa Civic Hospital, C4 1053 Carling Avenue, Ottawa, Ont. K1Y 4E9, Canada. (Llewellyn-Thomas H.A.; Pinfold S.P.; To T.; Harrison D.E.) Inst. for Clin. Evaluative Sciences, Toronto, Ont., Canada. (Sawka C.) Ontario Cancer Treatm. and Res. F., Toronto, Ont., Canada. CORRESPONDENCE ADDRESS A.M. O'Connor, Clinical Epidemiology Unit, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ont. K1Y 4E9, Canada. SOURCE Patient Education and Counseling (1997) 30:2 (143-153). Date of Publication: February 1997 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Purpose: To examine variations in physicians' opinions about the appropriateness and content of decision aids for women with breast cancer and criteria for their evaluation. Methods: Cross-sectional survey of all 144 Ontario oncologists by Dillman's mailed survey design. The response rate was 87%. Results: The predominant current practice pattern was to spontaneously inform patients about the treatment recommendations, degree of certainty regarding the recommendations, treatment regime, benefits and side effects. Most respondents (94%) endorsed patient decision aids, particularly when there was high uncertainly about providing adjuvant treatment. Over three-quarters endorsed measuring the following outcomes of decision aids: patients' clarity of trade-offs involved (e.g. survival vs. side effects); comprehension of treatment alternatives, risks and benefits; accuracy of expectations; decision satisfaction; anxiety; commitment to the decision; length of time to complete the decision aid; and decision uncertainty. The least support was for the use of the decision itself as an outcome measure. Conclusions: There is considerable consensus regarding the indications for, content and criteria for evaluating decision aids which should be considered when developing aids relevant to the needs of clinicians and patients. EMTREE DRUG INDEX TERMS antineoplastic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article decision making doctor patient relation education female human patient information physician priority journal risk benefit analysis EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997066395 MEDLINE PMID 9128616 (http://www.ncbi.nlm.nih.gov/pubmed/9128616) PUI L27094788 DOI 10.1016/S0738-3991(96)00948-2 FULL TEXT LINK http://dx.doi.org/10.1016/S0738-3991(96)00948-2 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 539 TITLE Patient education pamphlets about prevention, detection, and treatment of breast cancer for low literacy women AUTHOR NAMES Glazer H.R. Kirk L.M. Bosler F.E. AUTHOR ADDRESSES (Glazer H.R.; Kirk L.M.; Bosler F.E.) Univ. Texas Southwestern Med. Ctr., 5323 Harry Hines Boulevard, Dallas, TX 75235-9005, United States. CORRESPONDENCE ADDRESS L.M. Kirk, University of Texas, Southwestern Medical Ctr. at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9005, United States. SOURCE Patient Education and Counseling (1996) 27:2 (185-189). Date of Publication: March 1996 ISSN 0738-3991 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT The objective of this project was to identify and assess readily available patient education literature about prevention, detection and treatment of breast cancer for the patient with low literacy skills. The target population had a reading comprehension level of sixth grade or lower. Nineteen pamphlets were analyzed using RightWriter and were found to have an average readability index of 9.15, therefore requiring at least a ninth grade level of reading comprehension. As a consequence, many pieces of the available literature were inappropriate for the target population. There are implications as a broader group of health care providers becomes more involved in the treatment of low literacy patients. In providing patient education literature to poorly educated patients, special emphasis should be given to determining readability. Both currently available and newly created literature should be analyzed for readability before assuming it is an aid to patient education. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (diagnosis, prevention) mammography patient counseling patient education EMTREE MEDICAL INDEX TERMS article female human priority journal EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996080645 MEDLINE PMID 8788348 (http://www.ncbi.nlm.nih.gov/pubmed/8788348) PUI L26092404 DOI 10.1016/0738-3991(95)00834-9 FULL TEXT LINK http://dx.doi.org/10.1016/0738-3991(95)00834-9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 540 TITLE Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast AUTHOR NAMES Hillner B.E. Desch C.E. Carlson R.W. Smith T.J. Esserman L. Bear H.D. AUTHOR ADDRESSES (Hillner B.E.) Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0170, United States. (Desch C.E.; Carlson R.W.; Smith T.J.; Esserman L.; Bear H.D.) CORRESPONDENCE ADDRESS B.E. Hillner, Medical College of Virginia, Virginia Commonwealth University, Box 980170, Richmond, VA 23298-0170, United States. SOURCE Journal of Clinical Oncology (1996) 14:1 (70-77). Date of Publication: January 1996 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology, 330 John Carlyle Street, Suite 300, Alexandria, United States. ABSTRACT Purpose: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. Patients and Methods: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. Results: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7% and 74.1% for the initial mastectomy strategy, 91.0% and 72.1% for BCS plus RT, and 89.6% and 68.2% for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5%, compared with 63.3% for BCS plus RT, or 46.8% for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2%) compared with BCS plus RT (56.0%) or initial mastectomy (0%). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2%) compared with BCS alone (28.4%). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1%. Conclusion: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) carcinoma in situ (radiotherapy, surgery) intraductal carcinoma (radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adult article cancer survival case report clinical practice female human mammography mastectomy medical decision making priority journal surgical technique EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996018011 MEDLINE PMID 8558224 (http://www.ncbi.nlm.nih.gov/pubmed/8558224) PUI L26019999 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 541 TITLE Preventive medicine: Individual or community medicine? ORIGINAL (NON-ENGLISH) TITLE MEDECINE PREVENTIVE: MEDECINE INDIVIDUELLE OU COLLECTIVE? AUTHOR NAMES Eisinger F. AUTHOR ADDRESSES (Eisinger F.) Departement de Prevention, Ctr. Reg. de Lutte Contre le Cancer, 232, Bd Sainte-Marguerite, 13009 Marseille, France. CORRESPONDENCE ADDRESS F. Eisinger, Departement de Prevention, Ctr. Reg. de Lutte Contre le Cancer, 232, Bd Sainte-Marguerite, 13009 Marseille, France. SOURCE Journal d'Economie Medicale (1995) 13:2 (83-87). Date of Publication: 1995 ISSN 0294-0736 ABSTRACT At least three relevant factors coexist in medical decision making: patients' individual best interest, the community of patients' best interests, the community's best interests. Three examples of medical decision are analyzed in this way: a surgical aortic valve replacement, a theoretical randomized clinical trial and an authoritative psychiatric hospitalisation. In each of these situations there exist several possible patterns of weighting with the three relevant factors. The Tamoxifen trial controversy is then examined using a decision analysis expression that takes these factors into account. Different points of view lead to different decisions. This controversy may be partly due to the fact that physicians weight each of the three explanatory factors differently (Individual, collective and social) rather than being a question of scientific data or differences between ethical values. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision theory doctor patient relation preventive medicine EMTREE MEDICAL INDEX TERMS article breast cancer (drug therapy) clinical trial controlled study female human meta analysis CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1995197316 PUI L25200266 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 542 TITLE Physicians' expert cognition and the problem of cognitive biases AUTHOR NAMES Hamm R.M. Zubialde Z. AUTHOR ADDRESSES (Hamm R.M.; Zubialde Z.) Clinical Decision Making Program, Department of Family Medicine, Univ. of Oklahoma Health Sci. Center, 900 Northeast 10th St., Oklahoma City, OK 73104, United States. CORRESPONDENCE ADDRESS R.M. Hamm, Clinical Decision Making Program, Department of Family Medicine, Univ. of Oklahoma Health Sci. Center, 900 Northeast 10th St., Oklahoma City, OK 73104, United States. SOURCE Primary Care - Clinics in Office Practice (1995) 22:2 (181-212). Date of Publication: 1995 ISSN 0095-4543 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This article reviews the ways in which physicians reason in order to account for medical mismanagement due to cognitive errors. Whether physicians make decisions intuitively or analytically, they may err due to the approximations of human reasoning. Vigilance, education, and programs at the level of the medical system are suggested as measures to make decisions consistent with the logic of decision analysis so that the effects of cognitive errors are minimized. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) malpractice medical decision making medical specialist EMTREE MEDICAL INDEX TERMS adult breast calcification (surgery) cancer risk case report cognition competence diagnostic accuracy doctor patient relation female good clinical practice human mammography mastectomy medical education patient referral practice guideline primary medical care priority journal review sore throat EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1995165810 MEDLINE PMID 7617781 (http://www.ncbi.nlm.nih.gov/pubmed/7617781) PUI L25162959 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 543 TITLE Breast lump in an 85-year-old woman with dementia: A decision analysis AUTHOR NAMES Robinson B.E. Balducci L. AUTHOR ADDRESSES (Robinson B.E.; Balducci L.) Div. of Geriatric Medicine, Dept. of Internal Medicine, South Florida Univ. College of Med., 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States. CORRESPONDENCE ADDRESS B.E. Robinson, Div. of Geriatric Medicine, Dept. of Internal Medicine, South Florida Univ. College of Med., 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States. SOURCE Journal of the American Geriatrics Society (1995) 43:3 (282-285). Date of Publication: 1995 ISSN 0002-8614 BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Alzheimer disease breast carcinoma (diagnosis, radiotherapy, surgery) dementia medical decision making EMTREE MEDICAL INDEX TERMS aged article axillary lymph node cancer radiotherapy cancer survival case report controlled study female fine needle aspiration biopsy human lymph node dissection mammography mastectomy EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Neurology and Neurosurgery (8) Cancer (16) Gerontology and Geriatrics (20) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1995088937 MEDLINE PMID 7884120 (http://www.ncbi.nlm.nih.gov/pubmed/7884120) PUI L25087535 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 544 TITLE Decision making in surgery: management of symptomatic early breast carcinoma. AUTHOR NAMES Thomas P. AUTHOR ADDRESSES (Thomas P.) Whipps Cross Hospital, London. CORRESPONDENCE ADDRESS P. Thomas, Whipps Cross Hospital, London. SOURCE British journal of hospital medicine (1994) 51:6 (287-289). Date of Publication: 1994 Mar 16-Apr 5 ISSN 0007-1064 ABSTRACT The initial advice given to a patient with a proven breast carcinoma needs to be informed and sensitive. Breast specialists still have firm and differing views of the management of early breast carcinoma and, although a consensus approach is nearer now than it used to be, there is still sufficient variation to make it difficult for the surgical trainee. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) decision support system EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article cancer staging female human lymph node dissection mastectomy methodology multimodality cancer therapy pathology patient education LANGUAGE OF ARTICLE English MEDLINE PMID 8032564 (http://www.ncbi.nlm.nih.gov/pubmed/8032564) PUI L24924924 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 545 TITLE Breast-conserving treatment or mastectomy in early breast cancer: A clinical decision analysis with special reference to the risk of local recurrence AUTHOR NAMES Verhoef L.C.G. Stalpers L.J.A. Verbeek A.L.M. Wobbes T. Van Daal W.A.J. AUTHOR ADDRESSES (Verhoef L.C.G.; Stalpers L.J.A.; Verbeek A.L.M.; Wobbes T.; Van Daal W.A.J.) Institute for Radiotherapy, St. Radboud Univ. Hospital, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. CORRESPONDENCE ADDRESS L.C.G. Verhoef, Institute for Radiotherapy, St. Radboud Univ. Hospital, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. SOURCE European Journal of Cancer (1991) 27:9 (1132-1137). Date of Publication: 1991 ISSN 0277-5379 BOOK PUBLISHER Elsevier Ltd., Oxford, United Kingdom. ABSTRACT A clinical decision analysis was performed to judge the impact of local recurrences after breast-conserving treatment (BCT) on the (quality-adjusted) life expectancy of breast cancer patients. A life-long follow-up of two patient groups, one of which had undergone mastectomy and one BCT, was simulated by a Markov model of medical prognosis. Data used in the model originated from the literature. Since results in the source papers were not split according to stage, we performed two analyses: one with data from all source studies (T(1) and T(2)) and one with data from source studies, concerning only T(1) patients. In both analyses, the conclusion was that BCT yields better quality-adjusted life expectancy than mastectomy. Sensitivity analysis, however, identified subgroups of patients who should preferably undergo mastectomy. These subgroups are: patients preferring mastectomy to BCT, patients with a high risk of local recurrence, young patients and patients at high age, if they also have a high local recurrence risk. For these groups, patient preferences should play a major role in recommending treatment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) cancer therapy conservative treatment decision making decision theory EMTREE MEDICAL INDEX TERMS adult aged article female human priority journal EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1991274318 MEDLINE PMID 1835623 (http://www.ncbi.nlm.nih.gov/pubmed/1835623) PUI L21273624 DOI 10.1016/0277-5379(91)90310-A FULL TEXT LINK http://dx.doi.org/10.1016/0277-5379(91)90310-A COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 546 TITLE Use of CT scanning to optimise the localisation procedure for breast radiotherapy. AUTHOR NAMES Rattray G. AUTHOR ADDRESSES (Rattray G.) Radiotherapy Department King's College Hospital, London. CORRESPONDENCE ADDRESS G. Rattray, Radiotherapy Department King's College Hospital, London. SOURCE Radiography today (1989) 55:626 (11-15). Date of Publication: Jul 1989 ISSN 0954-8211 ABSTRACT The continually improving technology in breast screening is now allowing diagnosis of patients with early stage breast cancer who would otherwise not have presented for many years. Surgical techniques are directed to achieving the best possible cosmetic result following the surgery. Radiotherapy treatment machines are becoming more complex and sophisticated in design and capability. Why, therefore, should we not employ today's technology for the localisation process? This is a report of our experience in using CT scanning to localise the treatment volumes for breast patients over a period of one year. A comparison between marking patients by palpation and the use of CT scanning has prevented a number of patients being under-treated and has enabled the reduction of lung volume included in the treatment volume for other patients. It has also proved a valuable aid in the decision to use electron fields for mastectomy patients. Other means of localising the treatment volumes are considered in the light of our experiences. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (radiotherapy, surgery) computer assisted tomography EMTREE MEDICAL INDEX TERMS article female human lymph node mammography mastectomy methodology multimodality cancer therapy partial mastectomy radiography thorax radiography LANGUAGE OF ARTICLE English MEDLINE PMID 2590443 (http://www.ncbi.nlm.nih.gov/pubmed/2590443) PUI L20784570 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 547 TITLE Fine needle aspiration cytology: Its role in the management of breast tumours AUTHOR NAMES Lew W.Y.C. Lee W.H. AUTHOR ADDRESSES (Lew W.Y.C.; Lee W.H.) Department of Histopathology, Queen Elizabeth Hospital, Woodville, SA CORRESPONDENCE ADDRESS Department of Histopathology, Queen Elizabeth Hospital, Woodville, SA SOURCE Australian and New Zealand Journal of Surgery (1988) 58:12 (941-946). Date of Publication: 1988 ISSN 0004-8682 BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Fine needle aspiration (FNA) cytology is a cost-effective and clinically reliable tool in the management of breast tumours. This report summarizes the experience with 364 patients who had FNA of the breast. There was a total of 115 cancers of which 108 (93.9%) were diagnosed on FNA. There were no false positives amongst aspirates diagnosed as 'malignant'. Thirty-one patients had mastectomy with prior frozen section and nine had advanced or recurrent disease with no biopsy confirmation. FNA was 'suspicious of malignancy' in 12 patients of which 10 were malignant and two were benign on histology. There were 216 patients with 'benign' FNA and 28 FNA were 'unsatisfactory'. Biopsy confirmation was recommended in all clinically malignant or doubtful cases. Forty-one (19%) of the patients with 'benign' FNA and 13 (46%) of the 'unsatisfactory' group had excision biopsies which revealed six cancers, giving a false negative rate of 5.2%. FNA cytology gives rapid and reliable results which contribute towards planning of further management of the patient. It can replace the more painful tru-cut biopsy and reduce the need for excision biopsy and frozen section in the initial diagnosis of breast tumours. It is also an effective modality to monitor and confirm suspected recurrences. Although a negative FNA does not completely exclude malignancy, it can be used to reassure the surgeon and the patient and to support their decision not to operate. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (diagnosis, surgery) fine needle aspiration biopsy needle biopsy EMTREE MEDICAL INDEX TERMS adult aged cytology diagnosis female human major clinical study methodology EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1989012485 MEDLINE PMID 2849393 (http://www.ncbi.nlm.nih.gov/pubmed/2849393) PUI L19012485 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 548 TITLE Fine-needle aspiration biopsy of breast lesions. AUTHOR NAMES Caruthers B.S. AUTHOR ADDRESSES (Caruthers B.S.) Department of Family Practice, University of Michigan Medical School, Ann Arbor 48109-0708. CORRESPONDENCE ADDRESS B.S. Caruthers, Department of Family Practice, University of Michigan Medical School, Ann Arbor 48109-0708. SOURCE Postgraduate medicine (1988) 84:8 (46-51, 55-57). Date of Publication: Dec 1988 ISSN 0032-5481 ABSTRACT Fine-needle aspiration biopsy is a safe, cost-effective, and accurate technique, which has no contraindications and causes little discomfort. There is no breast lesion for which fine-needle biopsy is not appropriate. Results are available quickly to the patient and physician and aid in decision making about the necessity for excisional biopsy, mastectomy, or radiation therapy. False-negative rates may be decreased by adherence to proper technique and strict cytologic interpretation. A negative cytology report in the face of a clinically suspicious lesion mandates excisional biopsy. Fine-needle biopsy is valuable for diagnosis of breast cancer and can be easily learned and used by the clinician. Combining it with clinical examination and mammography increases the accuracy of diagnosis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor fibrocystic breast disease needle biopsy EMTREE MEDICAL INDEX TERMS article devices differential diagnosis female human mammography methodology pathology prediction and forecasting LANGUAGE OF ARTICLE English MEDLINE PMID 3194329 (http://www.ncbi.nlm.nih.gov/pubmed/3194329) PUI L19340638 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 549 TITLE quantitative approaches to clinical diagnosis of cancer in elderly patients AUTHOR NAMES Feussner J.R. Simel D.L. Matchar D.B. AUTHOR ADDRESSES (Feussner J.R.; Simel D.L.; Matchar D.B.) Department of Medicine, Division of General Internal Medicine, Health Service Research Field Program, Durham VA Medical Center, Durham, NC 27705 CORRESPONDENCE ADDRESS Department of Medicine, Division of General Internal Medicine, Health Service Research Field Program, Durham VA Medical Center, Durham, NC 27705 SOURCE Clinics in Geriatric Medicine (1987) 3:3 (447-461). Date of Publication: 1987 ISSN 0749-0690 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The ACS recommends that normal populations be screened for a few cancers, specifically colorectal, breast, cervical, and prostate. These early detection strategies are potentially attractive in that they seek to reduce mortality from cancer by detecting it early. However, because the knowledge base with regard to cancer detection in the elderly is sparse, a more general understanding of the strengths and the limitations of diagnostic testing is useful. A few characteristics of diagnostic tests provide key information, including the test sensitivity and specificity. In determining the clinical usefulness of a diagnostic test (the predictive value), the disease prevalence is essential. High disease prevalence often defines high-risk groups of patients for whom diagnostic testing is particularly rewarding. More sophisticated strategies, such as formal decision analysis and economic modeling, can be helpful not only in establishing policy, but also in providing the practicing geriatrician with a context in which to place patient-specific decisions. Formal decision analysis is particularly useful because the process of structuring the clinical problem often reveals the obvious solution. Decision analysis systematically lists diagnostic and treatment options and considers the utilities (values) that accompany each decision strategy. Economic modeling, where both costs and consequences of selected strategies are compared, has been enormously useful and has had a great impact on the recommendations made by the ACS for the early detection of cancer. However, by looking at these cost-effectiveness curves, the individual clinician can make choices when the recommendations are flexible, for example, the use of sigmoidoscopy at 3- to 5-year intervals. Finally, because mortality rates are so high in the elderly, and because comorbid diseases are so prevalent, all decisions regarding diagnostic testing for cancer must be placed in the specific context of the individual patient. By blending what are recommended as the 'best diagnostic strategies' with a knowledge of the needs and values of their individual patients, geriatricians can make wise recommendations to their patients or their patients' families. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aged malignant neoplasm EMTREE MEDICAL INDEX TERMS diagnosis economic aspect human short survey EMBASE CLASSIFICATIONS Cancer (16) Gerontology and Geriatrics (20) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987216058 MEDLINE PMID 3308043 (http://www.ncbi.nlm.nih.gov/pubmed/3308043) PUI L17148558 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 550 TITLE Predictive value of lectin binding on breast-cancer recurrence and survival AUTHOR NAMES Leathem A.J. Brooks S.A. AUTHOR ADDRESSES (Leathem A.J.; Brooks S.A.) Bland-Sutton Institute of Pathology, Middlesex Hospital, London W1P 7PN CORRESPONDENCE ADDRESS Bland-Sutton Institute of Pathology, Middlesex Hospital, London W1P 7PN SOURCE Lancet (1987) 1:8541 (1054-1056). Date of Publication: 1987 ISSN 0140-6736 ABSTRACT A new approach for predicting long-term survival of breast-cancer patients is the detection of carbohydrate expression in paraffin-embedded sections of the primary tumour. The binding of a lectin (HPA), derived from the albumin gland of the Roman snail, Helix pomatia, to N-acetyl-galactosaminyl oligosaccharides appears valuable in assessing long-term prognosis. The clinical progress of 179 patients, followed-up for 15-20 years, was related to staining of paraffin sections of their primary breast cancers by HPA. All patients had had mastectomy but were not stratified by pathology or treatment. There were significant differences, in premenopausal patients, between groups with and without HPA staining in both time to first recurrence and survival time. HPA binding provides an extra tool for staging to aid decisions in early adjuvant treatment, with the advantage of being applicable to routinely fixed paraffin-embedded material. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) lectin EMTREE DRUG INDEX TERMS carbohydrate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer EMTREE MEDICAL INDEX TERMS breast cytology diagnosis human human cell immunohistochemistry major clinical study priority journal prognosis recurrent disease survival therapy EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987128829 MEDLINE PMID 2883395 (http://www.ncbi.nlm.nih.gov/pubmed/2883395) PUI L17061329 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved.