To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis?

OBJECTIVE: In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. METHODS: In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. RESULTS: There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (ß 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (ß - 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (ß -0.34, p 0.03) and by immigrants (ß -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (ß 0.19/0.19/0.20/0.25; each p < 0.01). CONCLUSION: Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.

Fetal gastroschisis: a comparison of second vs. third-trimester bowel dilatation for predicting bowel atresia and neonatal outcomes.

PURPOSE: To compare various gestational ages and thresholds for diagnosing bowel dilatation in fetuses with gastroschisis and to evaluate the prognostic value of bowel dilatation for predicting postnatal bowel atresia and neonatal outcomes. MATERIALS AND METHODS: This was a retrospective observational study conducted from March 1997 to September 2009 that included 78 pregnancies with fetal gastroschisis. The predictive value of prenatal bowel dilatation for neonatal bowel atresia and postnatal complications was investigated in three subgroups: those with bowel dilatations ≥ 10 mm at a gestational age < 27 + 0 weeks, ≥ 10 mm at a gestational age < 30 + 0 weeks and ≥ 18 mm at a gestational age ≥ 30 weeks. RESULTS: Prenatally, 6 %, 81 % and 13 % of the bowel malformations were identified in the first, second and third trimesters, respectively. There were three stillbirths and three neonatal deaths, and the mean gestational age at delivery was 35.4 weeks (range 31 + 4 to 41 + 6). Bowel atresia was significantly correlated with prenatal bowel dilatation in all three subgroups. Bowel dilatations of ≥ 10 mm before 30 + 0 gestational weeks achieved the best performance in predicting bowel atresia, with a sensitivity of 89 % (8 / 9) and a specificity of 79 % (30 / 38). A prenatal bowel diameter ≥ 10 mm through 30 completed weeks was also the best predictor of a prolonged neonatal hospital stay ≥ 8 weeks (sensitivity = 61.1, 11 / 18, p = 0.002). CONCLUSION: Fetuses with isolated gastroschisis successfully underwent postnatal surgery in most cases (93.2 %), except for one termination, one intrauterine death and 3 cases of neonatal death. A fetal bowel dilatation > 10 mm before 30 + 0 weeks had the highest predictive value for postnatal bowel complications.

Tricuspid atresia with absent pulmonary valve and intact ventricular septum: intrauterine course and outcome of an unusual congenital heart defect.

The extremely rare syndrome including absent pulmonary valve associated with membranous tricuspid atresia or severe tricuspid stenosis, intact ventricular septum and patent ductus arteriosus has been reported sporadically in the postnatal literature. This cardiac defect is characterized by right ventricular dysplasia with asymmetrical ventricular septal hypertrophy, ventricular septum bulging into the left ventricle, small right ventricular cavity, membranous tricuspid atresia or severe stenosis with abnormal papillary muscles and leaflets and absence of the pulmonary valve leaflets. The only prenatal case reported so far was diagnosed at 33 weeks of gestation and terminated shortly thereafter; the natural history of prenatally diagnosed cases is therefore unknown. We report on the intrauterine course of a case diagnosed at 17 weeks of gestation that had a favorable postnatal outcome after palliation.