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1.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
3.
S Afr Med J ; 110(4): 271-273, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657737

RESUMO

Trastuzumab was added to the South African Essential Medicines List (EML) in 2017 for the adjuvant management of human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. However, access has remained inconsistent, as some provinces continue to regard trastuzumab as unaffordable within the contexts of their respective oncology budgets. The intention of providing access to trastuzumab through its inclusion on the EML, therefore, has not been met. The National EML Committee (NEMLC) recently reviewed newly published peer-reviewed information investigating the impact of a shorter trastuzumab treatment period on both clinical efficacy and safety. On account of this review, and with a view to improving access while reducing cost and toxicity, the NEMLC has revised the duration of trastuzumab therapy, i.e. from 12 months to 6 months in the adjuvant management of early HER2-positive breast cancer. This article explores and reports on the data used to make this policy amendment.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Medicamentos Essenciais , Duração da Terapia , Política de Saúde , Mastectomia , Formulação de Políticas , Trastuzumab/uso terapêutico , Antineoplásicos Imunológicos/economia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Orçamentos , Cardiotoxicidade/etiologia , Quimioterapia Adjuvante , Feminino , Acesso aos Serviços de Saúde , Humanos , Mastectomia Segmentar , Estadiamento de Neoplasias , Receptor ErbB-2/metabolismo , África do Sul , Trastuzumab/economia
4.
Medicine (Baltimore) ; 99(29): e21201, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702884

RESUMO

RATIONALE: We hypothesize that with the determination of lymph fistula location 3-dimensionally, application of appropriate pressure would promote fistula healing, and a secondary surgery may be avoided. Ga-labeled 1,4,7-triazacyclononane-N, N', N"-triacetic acid (NOTA) conjugated with truncated Evan blue (NEB) forms a complex with serum albumin in the interstitial fluid after it is locally injected and allows rapid visualization of the lymphatic system. PATIENT CONCERNS: A 44-year-old woman had a chief complaint of left nipple discharge. A 38-year-old woman came to the hospital after sensing a right breast mass. DIAGNOSES: The 2 patients were diagnosed with chylous fistula after breast cancer surgery based on the findings of a novel method, Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography. INTERVENTIONS: We successfully obtained clear images to locate the fistula using Ga-NEB positron emission tomography/computed tomography (PET/CT) for both patients. The lymphatic vessels and lymph nodes could be clearly visualized owing to the Ga-NEB activity during PET/CT. OUTCOMES: Three-dimensional positioning to locate the fistula could direct the application of the pressure dressing and reduce drainage markedly. LESSONS: Ga-NEB PET/CT may be a new method for diagnosing chylous fistula and providing guidance for treatment.


Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Fístula/etiologia , Mastectomia/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Adulto , Axila/anormalidades , Axila/cirurgia , Neoplasias da Mama/complicações , Feminino , Fístula/cirurgia , Humanos , Mastectomia/métodos , Derrame Papilar , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia
5.
Orv Hetil ; 161(29): 1221-1228, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32628622

RESUMO

INTRODUCTION: The significant need for breast reconstruction resulting from the spread of oncoplastic breast surgery raises a number of systemic issues. Clarification and regulation of the indications are needed for aesthetic changes of the reconstructed breast due to oncotherapy treatments, ageing and technical problems of implants; a number of operations, targeted aesthetic goals as well as surgical capacities and financial background should also be determined. AIM: Our aim was to conduct a survey on the opinions and needs of the Hungarian breast cancer population about a modern breast reconstruction system. PATIENT AND METHOD: A study was conducted enrolling 500 patients who underwent mastectomy with immediate or delayed reconstruction. A structured questionnaire containing eleven questions was used to measure the attitude for loss and reconstruction of breast, the expectation of cosmetic outcome and qualification of the operating surgeon and the needs relating to the health system and funding. RESULTS: The median age was 47 years (min.-max.: 26-73), 59% (n = 294) was married and 52% (n = 260) had graduated in university. The majority of women (70%; n = 348) would like to have nakedly also similar breasts after the reconstruction process. To achieve this, 43% (n = 217) and 37% (n = 184) would undergo maximum two or four procedures, respectively, supported by the national health insurance company. 86% (n = 430) would like to choose qualified breast surgeon for her treatment. CONCLUSION: The modern oncoplastic treatment raises complex, systemic issues. Women with breast cancer would like to have qualified breast surgeons restoring their breasts by two operations, all funded by the national health insurance company. Orv Hetil. 2020; 161(29): 1221-1228.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Hungria , Mastectomia Radical/métodos , Mastectomia Segmentar , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
6.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609452

RESUMO

Paget disease of the nipple is a rare presentation of breast cancer. It is sometimes mistaken for a benign skin condition of the nipple and surrounding areola, which can significantly delay the diagnosis and treatment. In over 90% of cases there is an underlying carcinoma, either ductal carcinoma in situ (DCIS) or invasive breast cancer. We present a rare case of Paget disease of the nipple without the typical characteristics, detected by simple nipple scraping technique. A 62-year-old woman presented with a small fissure on the left nipple with scant clear nipple discharge. There were no other changes to the nipple-areola complex. The mammography and ultrasound were unremarkable. However, nipple scraping provided the immediate cytological diagnosis of Paget disease. Breast MRI with core biopsy showed high grade ductal carcinoma in situ with suggestion of microinvasion, confirmed histologically after mastectomy. Nipple scraping is a simple and inexpensive technique, which can be used in the office without anesthesia and with minimal discomfort to the patient. It could allow for significantly earlier cancer detection and treatment at the earliest stage of breast cancer. However, if the results are negative, full thickness biopsy may be needed if clinically indicated.


Assuntos
Neoplasias da Mama/patologia , Mamilos/patologia , Doença de Paget Mamária/patologia , Patologia Clínica/métodos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Doença de Paget Mamária/cirurgia
7.
J Anesth Hist ; 6(2): 35-37, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32593374

RESUMO

In 1812, Frances (Fanny) Burney (born in 1752 and died in 1840) underwent a mastectomy performed by Larry without anaesthesia. In the days after surgery, Burney wrote a letter to her sister, Esther Burney, describing her experience. In total, the letter is four pages long including information on before, during and after the surgery. Although this letter has been cited in numerous texts, it has yet to be analysed from multiple perspectives, shedding new light on the history of anaesthesia.


Assuntos
Neoplasias da Mama/história , Historiografia , Mastectomia/história , Relações Médico-Paciente , Anestesia/história , Neoplasias da Mama/cirurgia , Correspondência como Assunto/história , Pessoas Famosas , Feminino , História do Século XVIII , História do Século XIX , Humanos , Literatura Moderna/história , Reino Unido
8.
Eur J Cancer ; 135: 101-102, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32563013
9.
Lancet ; 395(10237): 1613-1626, 2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32580883

RESUMO

BACKGROUND: We aimed to identify a five-fraction schedule of adjuvant radiotherapy (radiation therapy) delivered in 1 week that is non-inferior in terms of local cancer control and is as safe as an international standard 15-fraction regimen after primary surgery for early breast cancer. Here, we present 5-year results of the FAST-Forward trial. METHODS: FAST-Forward is a multicentre, phase 3, randomised, non-inferiority trial done at 97 hospitals (47 radiotherapy centres and 50 referring hospitals) in the UK. Patients aged at least 18 years with invasive carcinoma of the breast (pT1-3, pN0-1, M0) after breast conservation surgery or mastectomy were eligible. We randomly allocated patients to either 40 Gy in 15 fractions (over 3 weeks), 27 Gy in five fractions (over 1 week), or 26 Gy in five fractions (over 1 week) to the whole breast or chest wall. Allocation was not masked because of the nature of the intervention. The primary endpoint was ipsilateral breast tumour relapse; assuming a 2% 5-year incidence for 40 Gy, non-inferiority was predefined as ≤1·6% excess for five-fraction schedules (critical hazard ratio [HR] of 1·81). Normal tissue effects were assessed by clinicians, patients, and from photographs. This trial is registered at isrctn.com, ISRCTN19906132. FINDINGS: Between Nov 24, 2011, and June 19, 2014, we recruited and obtained consent from 4096 patients from 97 UK centres, of whom 1361 were assigned to the 40 Gy schedule, 1367 to the 27 Gy schedule, and 1368 to the 26 Gy schedule. At a median follow-up of 71·5 months (IQR 71·3 to 71·7), the primary endpoint event occurred in 79 patients (31 in the 40 Gy group, 27 in the 27 Gy group, and 21 in the 26 Gy group); HRs versus 40 Gy in 15 fractions were 0·86 (95% CI 0·51 to 1·44) for 27 Gy in five fractions and 0·67 (0·38 to 1·16) for 26 Gy in five fractions. 5-year incidence of ipsilateral breast tumour relapse after 40 Gy was 2·1% (1·4 to 3·1); estimated absolute differences versus 40 Gy in 15 fractions were -0·3% (-1·0 to 0·9) for 27 Gy in five fractions (probability of incorrectly accepting an inferior five-fraction schedule: p=0·0022 vs 40 Gy in 15 fractions) and -0·7% (-1·3 to 0·3) for 26 Gy in five fractions (p=0·00019 vs 40 Gy in 15 fractions). At 5 years, any moderate or marked clinician-assessed normal tissue effects in the breast or chest wall was reported for 98 of 986 (9·9%) 40 Gy patients, 155 (15·4%) of 1005 27 Gy patients, and 121 of 1020 (11·9%) 26 Gy patients. Across all clinician assessments from 1-5 years, odds ratios versus 40 Gy in 15 fractions were 1·55 (95% CI 1·32 to 1·83, p<0·0001) for 27 Gy in five fractions and 1·12 (0·94 to 1·34, p=0·20) for 26 Gy in five fractions. Patient and photographic assessments showed higher normal tissue effect risk for 27 Gy versus 40 Gy but not for 26 Gy versus 40 Gy. INTERPRETATION: 26 Gy in five fractions over 1 week is non-inferior to the standard of 40 Gy in 15 fractions over 3 weeks for local tumour control, and is as safe in terms of normal tissue effects up to 5 years for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Neoplasias da Mama/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Mastectomia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Hipofracionamento da Dose de Radiação , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Medição de Risco/métodos , Resultado do Tratamento , Reino Unido/epidemiologia
11.
Medicine (Baltimore) ; 99(22): e20427, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481443

RESUMO

To describe social support, self-efficacy, and exercise adherence and to measure the correlations among these factors in postoperative breast cancer patients in Southwest China.Social support, self-efficacy, and exercise adherence are interacting factors that contribute to physical and mental health and quality of life. Little is known about the status of these factors in Southwest China, and little research has explored the relationships among them.Using a stratified sampling method, we selected patients who underwent modified radical mastectomy in 20 secondary and tertiary comprehensive hospitals in Southwest China. A descriptive cross-sectional study was conducted. Questionnaires were given to 632 breast cancer patients who met the inclusion and exclusion criteria (from August 2018 to February 2019). The questionnaire included the following 4 sections: general information, perceived social support scale, strategies used by people to promote health, and postoperative functional exercise adherence scale. Structural equation modeling was used to evaluate the hypothesized relationships among social support, self-efficacy, and exercise adherence.The level of social support of postoperative patients with breast cancer in Southwest China was high (63.43 ±â€Š9.25); however, levels of self-efficacy (95.00 ±â€Š18.81) and exercise adherence (49.07 ±â€Š10.57) were moderate. Higher social support correlated with higher exercise adherence (r = 0.526, P < .01). Higher self-efficacy was also correlated with higher exercise adherence (r = 0.427, P < .01). In-home support, out-of-home support, and self-efficacy had direct positive effects on exercise adherence (ß = 0.37, P < .01; ß = 0.23, P < .01; and ß = 0.32, P < .01, respectively); in-home support indirectly affected exercise adherence through self-efficacy (ß = 0.58, P < .01).Social support and self-efficacy correlated highly with exercise adherence. It is recommended that attention be paid to the development of self-efficacy and social support during postoperative rehabilitation to improve the exercise adherence of postoperative breast cancer patients.


Assuntos
Neoplasias da Mama/psicologia , Exercício Físico/psicologia , Adulto , Neoplasias da Mama/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Mastectomia , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Autoeficácia , Apoio Social , Inquéritos e Questionários
12.
Breast ; 52: 110-115, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502796

RESUMO

BACKGROUND: Corona Virus Disease 19 (COVID-19) had a worldwide negative impact on healthcare systems, which were not used to coping with such pandemic. Adaptation strategies prioritizing COVID-19 patients included triage of patients and reduction or re-allocation of other services. The aim of our survey was to provide a real time international snapshot of modifications of breast cancer management during the COVID-19 pandemic. METHODS: A survey was developed by a multidisciplinary group on behalf of European Breast Cancer Research Association of Surgical Trialists and distributed via breast cancer societies. One reply per breast unit was requested. RESULTS: In ten days, 377 breast centres from 41 countries completed the questionnaire. RT-PCR testing for SARS-CoV-2 prior to treatment was reported by 44.8% of the institutions. The estimated time interval between diagnosis and treatment initiation increased for about 20% of institutions. Indications for primary systemic therapy were modified in 56% (211/377), with upfront surgery increasing from 39.8% to 50.7% (p < 0.002) and from 33.7% to 42.2% (p < 0.016) in T1cN0 triple-negative and ER-negative/HER2-positive cases, respectively. Sixty-seven percent considered that chemotherapy increases risks for developing COVID-19 complications. Fifty-one percent of the responders reported modifications in chemotherapy protocols. Gene-expression profile used to evaluate the need for adjuvant chemotherapy increased in 18.8%. In luminal-A tumours, a large majority (68%) recommended endocrine treatment to postpone surgery. Postoperative radiation therapy was postponed in 20% of the cases. CONCLUSIONS: Breast cancer management was considerably modified during the COVID-19 pandemic. Our data provide a base to investigate whether these changes impact oncologic outcomes.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Mastectomia/métodos , Pneumonia Viral/epidemiologia , Radioterapia/métodos , Antineoplásicos/uso terapêutico , Betacoronavirus , Quimioterapia Adjuvante , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Gerenciamento Clínico , Europa (Continente)/epidemiologia , Perfilação da Expressão Gênica , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Radioterapia Adjuvante , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
13.
Anticancer Res ; 40(6): 3543-3550, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487656

RESUMO

BACKGROUND/AIM: A retrospective study was performed in 246 breast cancer patients to define whether tumor-to-nipple distance (TND) assessment by breast MRI may select patients eligible to nipple-sparing mastectomy (NSM) as compared to permanent section assessment of retroareolar margin. PATIENTS AND METHODS: Pre- and post-operative parameters including imaging data, histology of the primary tumor, biologic prognostic factors, and adjuvant regimens were retrieved; patients with close/positive retroareolar margins underwent nipple or NAC excision. The primary endpoint was loco-regional recurrence (LRR). RESULTS: Patients with TND ≤2 cm had a significantly higher rate of invasive ductal carcinoma (p<0.003) and excision margins less than 2 mm (p<0.000). Eleven retroareolar specimens were positive at definitive pathology; final re-excision specimen examination showed residual disease in seven patients (63.6%). At a median follow-up of 31 to 33 months, no NAC recurrence did occur; disease-free survival was more than 96%, and LRR was homogeneously distributed among TND subgroups. CONCLUSION: Therapeutic NSM is a safe procedure independently of TND assessed at preoperative breast MRI. Permanent section assessment of retroareolar tissue is more accurate and cost-effective than frozen section. Furthermore, delayed nipple and/or NAC excision did not impair local disease control.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Margens de Excisão , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamoplastia/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Mamilos/cirurgia , Recidiva , Carga Tumoral
14.
A A Pract ; 14(7): e01235, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32539267

RESUMO

Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. The latter group poses the greatest risk of transmission. Given limited capacities in most health care systems, diagnostic testing is mainly performed in symptomatic patients or those with relevant exposure. We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.


Assuntos
Infecções Assintomáticas , Infecções por Coronavirus/diagnóstico , Pessoas em Situação de Rua , Cuidados Intraoperatórios , Mastectomia , Pneumonia Viral/diagnóstico , Extubação/métodos , Asma/complicações , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Feminino , Humanos , Hipertensão/complicações , Hipóxia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Pandemias , Pneumonia Viral/complicações , Reação em Cadeia da Polimerase , Respiração com Pressão Positiva , Respiração Artificial/métodos
15.
Medicine (Baltimore) ; 99(22): e20100, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481376

RESUMO

To investigate the feasibility of single-port endoscopic mastectomy via the lateral chest approach in the treatment of Simon grade II gynecomastia.Data from 12 patients with grade II gynecomastia admitted from January 2017 to November 2018 were retrospectively analyzed, and related satisfaction surveys were conducted 6 months after the operation.All surgeries were successfully performed under single-port endoscopy, and no patients were converted to open surgery. There were no serious complications related to the surgery, and all the patients were satisfied with the postoperative appearance.The application of single-port endoscopy in the surgical treatment of grade II gynecomastia is safe and reliable.


Assuntos
Endoscopia/métodos , Ginecomastia/cirurgia , Mastectomia/métodos , Estudos de Viabilidade , Feminino , Humanos , Satisfação do Paciente , Estudos Retrospectivos , Tórax
16.
Breast Cancer Res Treat ; 182(3): 515-521, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32529409

RESUMO

PURPOSE: Cryoablation is a minimally-invasive percutaneous procedure that is capable of reducing the psychosocial burden of surgical delay while also decreasing the morbidity of breast cancer therapy. The purpose of this editorial is to discuss the potential role of cryoablation for reducing the psychosocial burden of surgical delay during the COVID-19 pandemic by expediting the management of breast cancer while also lessening demand on limited healthcare resources. METHODS: This editorial critiques current expert opinion recommendations that aim to reduce viral transmission and preserve healthcare resources during the COVID-19 pandemic by advocating delay of elective breast cancer surgery. RESULTS: The editorial summarizes the current state of the evidence that supports the selective use of cryoablation as a definite or stopgap measure in the management of breast cancer during the COVID-19 pandemic or when healthcare resources are limited. CONCLUSIONS: As an office-based procedure performed under local anesthesia, cryoablation eliminates the need for operating room personnel and equipment while also reducing the psychosocial impact of delayed breast cancer surgery. By reducing the number of patient and healthcare provider interactions, cryoablation not only decreases the risk of viral transmission but also the need for personal protective devices during resource-limited times.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Ansiedade/psicologia , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Criocirurgia/métodos , Mastectomia , Terapia Neoadjuvante , Pneumonia Viral/epidemiologia , Tempo para o Tratamento , Procedimentos Cirúrgicos Ambulatórios , Betacoronavirus , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Mastectomia Segmentar , Estadiamento de Neoplasias , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Medição de Risco
17.
Breast Cancer Res Treat ; 182(3): 527-530, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32556796

RESUMO

PURPOSE: The Coronavirus pandemic has exposed substantial racial and ethnic health and healthcare disparities. Black breast cancer patients face significant disparities in stage of presentation, surgical management, and mortality. The objective of this editorial is to examine the possible implications of the surgical delay imposed by the pandemic on black breast cancer patients. METHODS: The American College of Surgeons, the Society of Surgical Oncology, and the American Society of Breast Surgeons recommendations for surgical delay during the Coronavirus Disease 2019 (COVID-19) were evaluated and discussed. RESULTS: Guidelines by major surgical organizations on surgical delay for breast cancer patients may inadvertently exacerbate disparities in time to surgery for black breast cancer patients. Our recommendations to better characterize the impact of these guidelines on surgical delay among vulnerable populations include the following: (1) track time from biopsy-proven diagnosis to surgery by race and ethnicity, (2) document patient and institution-related reasons for surgical delay, (3) record patient and disease-related variables/reasons for the selection of breast conservation surgery, mastectomy, and reconstruction by race and ethnicity, and (4) collect data on impactful social determinants of health such as financial reserve, housing conditions, stress, and transportation. CONCLUSIONS: The COVID-19 pandemic may exacerbate delays in time to surgery among black breast cancer patients. Surgeons should incorporate collection of social determinants of health into their clinical practice to better understand the impact of COVID-19 on racial and ethnic disparities in surgical management.


Assuntos
Afro-Americanos , Neoplasias da Mama/cirurgia , Infecções por Coronavirus/epidemiologia , Disparidades em Assistência à Saúde/etnologia , Mastectomia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde/etnologia , Tempo para o Tratamento , Betacoronavirus , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia , Mastectomia Segmentar , Mortalidade , Estadiamento de Neoplasias , Pandemias , Estados Unidos/epidemiologia
18.
Breast Cancer Res Treat ; 182(3): 679-688, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32562119

RESUMO

PURPOSE: As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. METHODS: IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. RESULTS: Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. CONCLUSION: This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implant-based breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Melhoria de Qualidade , Adulto , Assistência ao Convalescente , Anestesiologia , Betacoronavirus , Implante Mamário , Implantes de Mama , Protocolos Clínicos , Infecções por Coronavirus/epidemiologia , Eficiência , Serviço Hospitalar de Emergência , Feminino , Recursos em Saúde , Serviços de Assistência Domiciliar , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Pandemias , Readmissão do Paciente , Assistência Perioperatória/métodos , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Biópsia de Linfonodo Sentinela , Cirurgia Plástica , Oncologia Cirúrgica , Telemedicina , Dispositivos para Expansão de Tecidos
19.
Medicine (Baltimore) ; 99(22): e19991, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481367

RESUMO

To analyze patient satisfaction and the predictive factors characterizing three types of one-stage immediate breast reconstruction (IBR) after mastectomy, including prosthesis, latissimus dorsi myocutaneous flap (LDMF), transverse rectus abdominis myocutaneous (TRAM) flap techniques.Data were collected via face-to-face or telephone interviews from eight breast centers in China from January 2012 to December 2016. A standardized questionnaire that evaluated the general satisfaction and aesthetic satisfaction was sent to patients who had undergone IBR. Logistic regression analysis was performed to identify risk factors associated with patient satisfaction among the three types of breast reconstruction.A total of 412 questionnaires were sent out, and 309 copies were collected including 226 prosthesis, 46 LDMF, and 37 pedicle TRAM reconstruction. Logistic regression analysis showed that general satisfaction and aesthetic satisfaction were significantly correlated with radiotherapy (P < .001, P = .018), respectively. Besides, the aesthetic satisfaction was also associated with nipple-areola complex (NAC) preservation (P < .001).Our multi-center study identified factors of higher patient satisfaction, like NAC preservation and absence of radiotherapy, in order to help breast surgeons make better decisions about individualized reconstruction plan.


Assuntos
Implantes de Mama/psicologia , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Mastectomia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Implantes de Mama/estatística & dados numéricos , Feminino , Humanos , Mamoplastia/psicologia , Pessoa de Meia-Idade , Reto do Abdome/transplante , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos/estatística & dados numéricos
20.
In Vivo ; 34(3 Suppl): 1651-1659, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32503825

RESUMO

BACKGROUND/AIM: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. PATIENTS AND METHODS: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. RESULTS: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. CONCLUSION: COVID-19-related anxiety could affect patients' decision-making process.


Assuntos
Ansiedade/psicologia , Biópsia com Agulha de Grande Calibre/psicologia , Neoplasias da Mama/psicologia , Infecções por Coronavirus/psicologia , Tomada de Decisões , Procedimentos Cirúrgicos Eletivos/psicologia , Medo/psicologia , Mastectomia/psicologia , Pneumonia Viral/psicologia , Recusa do Paciente ao Tratamento/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Atitude Frente a Saúde , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Itália , Mamografia , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Fatores Socioeconômicos , Ultrassonografia Mamária , Vácuo
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