[Oncologic Care of Breast Cancer Patients with Preexisting Disabilities: Results of a Qualitative Study on Perceived Barriers, Communication Difficulties, and Needs]. / Die onkologische Versorgung von Brustkrebspatientinnen mit vorbestehender Behinderung ­ Ergebnisse einer qualitativen Studie über wahrgenommene Barrieren, kommunikative Schwierigkeiten und Bedarfe.

Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.

Are There Disparities in Surgical Treatment for Breast Cancer Patients with Prior Physical Disability A Path Analysis.

INTRODUCTION: Cancer care for patients with prior physical disability has hardly been researched in clinical research, health services research, or special education. This article aims to compare the severity of disease and the surgical treatment of diagnosed breast cancer patients with and without prior physical disability. METHODS: A total of 4,194 patients with primary breast cancer who underwent surgery in a breast cancer center in North Rhine-Westphalia, Germany, participated in an annual postoperative postal survey, which was complemented by clinical data. Latent class analysis and logit path models were applied to study (1) differences in terms of UICC staging and local cancer treatment between patients with and without prior physical disability and (2) respective differences by disability severity. RESULTS: Patients with physical disability (n = 780; 18.7%) had a higher chance of receiving mastectomy compared to breast-conserving therapy, even after controlling for socioeconomic status and UICC staging. Disability severity is directly and indirectly associated with receiving a mastectomy. CONCLUSION: In light of the research gap on disability and cancer, this work indicates disparities in care for breast cancer patients with prior physical disability. Inequalities might be attributable to (1) unequal access to care, (2) individual preferences and difficulties, or (3) medical difficulties.

[Influence of Sociodemographic Factors on Type of and Stage at Diagnosis in Breast Cancer]. / Zum Einfluss soziodemografischer Faktoren auf die Art der Verdachtsdiagnosestellung und das Tumorstadium bei Erstdiagnose von Brustkrebs.

This study examines the influence of sociodemographic factors on the type of and stage at diagnosis in breast cancer in Germany. METHOD: As part of the certification of the breast cancer centers by the German Cancer Society (DGK), the Institute of Medical Sociology, Health Services and Rehabilitation Science (IMVR) conducted nationwide post-stationary postal patient surveys (n=852). The influence of sociodemographic factors on the type of diagnosis and on the stage at diagnosis were each analyzed using a multinomial logistic regression. RESULTS: 45.5% palpated the tumor by themselves, 33.4% were diagnosed by mammography screening and 16.6% by gynecological check-up. Being diagnosed by screening was associated with an early stage cancer. Furthermore, breast cancer patients without private health insurance or with a low educational level were less likely to be diagnosed by a gynecological check-up. Patients within screening age (50-69) had higher odds for an early stage breast cancer. Patients with a low educational level had lower odds for an early stage breast cancer. CONCLUSION: Fifty percent of the breast cancer patients were not diagnosed by screening. Mammography screening appears to be more sensitive in detecting early stage cancer, since we found an association between diagnosis by screening and an early stage cancer. Age outside of the screening range and a low educational level might be risk factors for an advanced stage breast cancer. High screening rates, especially for these risk groups, seem to be important for early detection of breast cancer.

[Is There An Association Between Audit Results and Patient Experiences at Breast Centres in North Rhine-Westphalia?] / Gibt es einen Zusammenhang zwischen den Auditergebnissen und den Patientinnenerfahrungen in Brustzentren in Nordrhein-Westfalen?

AIM OF THE STUDY: To ensure and improve the quality of care, patients with breast cancer in North Rhine-Westphalia are supposed to be treated in certified breast centres only. To obtain this certification, every 3 years all centres must undergo an auditing process. They also have to participate in an annual patient survey. While some studies have evaluated the benefit of certified centres regarding the quality of care offered, here we evaluate the relationship between the audit results and the experiences of patients. METHODS: The quantitative results of the audit reports of 2014-2016 of breast centres in North Rhine-Westphalia were linked by multilevel analyses with different scales of the annual, post-operative, postal survey of primary breast cancer patients. RESULTS: Audit reports and survey data on 3016 patients from 33 breast centres were examined and after adjusting for multiple testing, no statistically significant interrelation was found. CONCLUSION: There are no associations between the results of a centre in the audit and the experiences of the patients. It appears that patients have a distinctive, subjective perception that cannot be represented by the audits alone, even though patient orientation is explicitly requested in the certification catalogue. This result underlines the benefit of the obligatory annual patient survey because it can provide information that apparently cannot be obtained from other sources, such as certification audits. CONCLUSION: As a whole, an association between the audit results of a centre and the experiences of the patients treated there are weak. The audit results do correlate with the perceived process organization. However, other dimensions of patient experience are distinctive and subjective. Even though patient orientation is explicitly requested in the certification requirements, patient experience is not be represented by the audits alone. This finding underlines the benefit of obligatory annual patient surveys because they can provide additional information.

How do breast cancer patients experience multidisciplinary tumor conferences? - A description from the patient perspective.

OBJECTIVES: Aim of this study was to investigate the experiences of breast cancer patients who participated in multidisciplinary tumor conferences (MTCs). STUDY DESIGN: Data from two consecutive years of an annual postal survey of patients with primary breast cancer were combined. Data was collected between February and July 2015 (response rate 72%) and 2016 (response rate 73%) from N = 8893 patients (ICD-10 C50) after hospital discharge from 86 breast cancer center hospitals in North Rhine-Westphalia, Germany. The study used a mixed-methods design. Standardized quantitative survey questions were analyzed descriptively and an open-ended question was analyzed using qualitative content analysis. RESULTS: Around 9% of the patients were invited to participate in a multidisciplinary tumor conference (MTC) and 49% of the invited patients reported actual participation in a MTC. Approximately 87% of those patients did not regret their participation in the MTC. The qualitative analysis from the open-ended question indicated that MTC participation was perceived by patients as being both supportive and informative (n = 109 expressions). However, some patients reported difficult experiences and emotional reactions during and after participation (n = 37 expressions). Altogether, the patients' perception was divided into positive and negative, cognitive and emotional experiences following participation in a MTC. CONCLUSION: The perception of the MTCs varies between the participating patients. Further research on advantages and disadvantages for patients and particularly on the feasibility from the provider's perspective is necessary.

The initial clinical interview--can it reduce cancer patients' fear?

PURPOSE: A common phenomenon among cancer patients is a fear of cancer recurrence or cancer progression (FOP). The aim of the present study was to analyze whether the oncologist is able to reduce patients' FOP at the initial clinical interview. METHOD: A prospective, longitudinal study included patients who were consulting private-practice oncologists in Germany for the first time. Recruitment was carried out by 44 members of the Professional Organization of Office-Based Hematologists and Oncologists. In the patient surveys, data on colon cancer patients' perceptions of communications with their oncologist and on patient-reported outcomes were collected over a period of 6 months. The present study analyzed the patients' data before their first consultation (T 0) and within 3 days after the first consultation (T 1). RESULTS: A total of 169 patients agreed to participate in the study. Backwards multiple regression analysis was conducted to determine whether the change (T 0-T 1) in FOP is associated with demographic, medical, or psychosocial determinants, or with the physician-patient communication. A significant association was found between the change in FOP and interruptions to the conversation, the comprehensibility of the information provided, the extent of perceived empathy from the physician, and the patient's social support and family status. CONCLUSION: Private social support and the initial medical encounter can help reduce FOP. Particularly, oncologists should ensure that they facilitate the presentation of information in a comprehensible way while avoiding interruptions and that they take particular care of patients with poor social support.