Psychosocial and Sexual Well-Being Following Nipple-Sparing Mastectomy and Reconstruction.

Nipple-sparing mastectomy (NSM) is considered an oncologically safe option for select patients. As many patients are candidates for nipple-sparing or skin-sparing mastectomy (SSM), reliable patient-reported outcome data are crucial for decision-making. The objective of this study was to determine whether patient satisfaction and/or health-related quality of life (HRQOL) were improved by preservation of the nipple with NSM compared to SSM and nipple reconstruction. Subjects were identified from a prospectively maintained database of patients who completed the BREAST-Q following mastectomy and breast reconstruction between March and October 2011 at Memorial Sloan Kettering Cancer Center. Fifty-two patients underwent NSM followed by immediate expander-implant reconstruction. A comparison group consisted of 202 patients who underwent SSM followed by immediate expander-implant reconstruction and later nipple reconstruction. HRQOL and satisfaction domains as measured by BREAST-Q scores were compared in multivariate linear regression analyzes that controlled for potential confounding factors. NSM patients reported significantly higher scores in the psychosocial (p = 0.01) and sexual well-being (p = 0.02) domains compared to SSM patients. There was no significant difference in the BREAST-Q physical well-being, satisfaction with breast, or satisfaction with outcome domains between the NSM and SSM groups. NSM is associated with higher psychosocial and sexual well-being compared to SSM and nipple reconstruction. Preoperative discussion of such HRQOL outcomes with patients may facilitate informed decision-making and realistic postoperative expectations.

Visible ink: A flexible and individually tailored writing intervention for cancer patients.

OBJECTIVES: Subjective reports on the effectiveness of and satisfaction with writing interventions in medical populations have indicated that they can have a profound impact on patients. Further, past research on these programs has demonstrated that they can lead to a number of different positive outcomes depending on the personal characteristics of the participating patients and the type of writing with which they are tasked. For this reason, a flexible and individually tailored writing intervention may be particularly effective for patients, molding its approach to their desires and backgrounds. This paper examines Visible Ink, a writing program for cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) that follows this model. METHODS: At Visible Ink's First Fall Writing Festival in November 2012, an optional survey was provided to all program participants in attendance, capturing both quantitative and qualitative information on patient experiences in the program. Twenty-nine surveys were completed. RESULTS: The program appears to have a variety of positive effects, including fostering personal growth and providing a positive distraction. Respondents reported that they write in a number of different genres on topics both related and not related to their illnesses, which supports the flexible model of the program. All respondents indicated that they would recommend the program to others, and satisfaction with the program's general approach (i.e., individualized work with a writing coach) was unanimous. A few areas for potential improvement were also identified, most of which involved expanding the services and events offered by the program. SIGNIFICANCE OF RESULTS: Despite the limitations of this survey (e.g., small sample size and low response rate), its results support the promise of the Visible Ink model and demonstrate participants' satisfaction with the program. Future research can more thoroughly examine Visible Ink's effectiveness, and additional resources could enable the program to expand.

Patient Death Debriefing Sessions to Support Residents' Emotional Reactions to Patient Deaths.

BACKGROUND: There is no standard way to help residents deal with the emotional impact of patient deaths. Most available curricula are time and resource intensive. OBJECTIVE: We introduced "Patient Death Debriefing Sessions" into an inpatient medical oncology rotation at Memorial Sloan Kettering Cancer Center to provide a structured yet practical way to address residents' emotional reactions following the death of a patient. A questionnaire was used to evaluate the impact of these sessions. METHODS: Patient Death Debriefing Sessions consist of a brief (~10 minutes), real-time (within 24-48 hours), consistent (following each death), attending physician-led debriefing that focuses on internal medicine residents' emotional reactions following patient deaths. Sessions were guided by a pocketcard tool and did not require faculty training. Residents completing a 4-week medical oncology rotation were surveyed before and after their rotation. Prerotation and postrotation mean differences were evaluated based on the number of sessions they participated in (0 to ≥ 3) using analyses of variance. RESULTS: Ninety-one of 92 participants spanning all training levels completed questionnaires (99% response rate). Of these, 79 (87%) encountered a patient death and were included in the analyses. Overall, residents found debriefing sessions helpful, educational, and appreciated attending physician leadership. The number of debriefing sessions positively influenced residents' perception of received support. CONCLUSIONS: This high-yield, novel pilot curriculum supported residents' emotional reactions to patient deaths and may foster communication with team members, including supervising attending physicians. This program is easily implemented and could be adapted for use in other clinical settings.