Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: a randomized clinical trial.

INTRODUCTION: Despite the large number of clinical trials on breast cancer, patient-related factors such as perioperative anxiety and level of knowledge about the disease and treatment have not been included in mainstream research efforts. This randomized trial was performed to evaluate the impact of information, provided preoperatively, on anxiety and knowledge of women undergoing mastectomy for breast cancer. METHODS: Sixty consecutive patients with breast cancer, admitted for a mastectomy, as primary treatment for breast cancer, with no previous cancer history, were randomized to receive structured information (short video about practical aspects of the hospital stay, surgical and adjuvant treatment) in addition to the routine informed consent procedure for surgery or the routine informed consent only. Anxiety and subjective knowledge levels were measured with the visual analogue scales; in addition, knowledge was assessed with a questionnaire. RESULTS: There was no significant effect of the additional information on perioperative anxiety or knowledge (subjective). Significantly more patients in the additional information group correctly listed all major available treatment options compared to the patients that received routine information (preoperatively 54% vs. 19%; p = 0.0101; 7 days postoperatively 50% vs.19%; p = 0.0367). CONCLUSIONS: Use of an informational video, preoperatively, did not significantly affect perioperative anxiety or subjective knowledge. Additional research is needed on effective delivery of disease- and treatment-specific information perioperatively.

Surgical management of solitary metastatic melanoma.

The results of non-surgical treatment of advanced stage melanoma are disappointing. Carefully selected stage IV melanoma patients can profit from an aggressive surgical approach. The possibilities of surgical treatment of solitary and single-organ metastasis of melanoma are discussed for most common metastatic sites.

Metastasis to the breast--a clinical challenge in outpatient.

Metastatic tumours of the breast are often misdiagnosed as a primary breast malignancy. This erroneous diagnosis can lead to unnecessary mutilating surgery and to delays in applying appropriate treatment. We have analyzed the clinical features of seven patients presenting initially with a breast mass which, after further investigation, proved to be metastasis from a non-breast primary tumour. The treatment of metastatic breast tumours depends on the nature of the primary tumour. Metastases of solid tumours are treated with local excision. Lymphomas are treated with appropriate systemic therapy. The prognosis for patients with metastatic tumours in the breast is poor.

Cavitated tumor as a clinical subentity in squamous cell lung cancer patients.

Cavity in lung cancer patients is usually attributed to worse prognosis, which could be caused by diagnostic difficulties and late surgery. The aim of this study is to identify cavity as clinical subentity in squamous cell lung cancer (SqCLC) patients. 1094 patients with I0 - III0 of SqCLC underwent surgery with the purpose of radical lobectomy or pneumonectomy. The patients were divided into two groups: 100 patients with cavity (cSqCLC) and 994 with solid tumor (sSqCLC). The clinical, histological and prognostic features were compared for the both groups. The Cox multivariate analysis of the prognostic factors was performed. The survival curves for both groups were compared. cSqCLC patients showed lower body mass and more frequent hemoptoe. They had larger tumors, located peripherically, rarer nodal involvement and atelectasis. Despite the similar cancer stage and the exploratory thoracotomies ratio, cSqCLC patients lived shorter. The survival curves for both groups were different: in all population, for patients after radical surgery and even after exploratory thoracotomy. We conclude that the cavitation in SqCLC patients can be regarded as a separate subentity related to worse prognosis.