Management of the Axilla in Early-Stage Breast Cancer: Ontario Health (Cancer Care Ontario) and ASCO Guideline.

PURPOSE: To provide recommendations on the best strategies for the management and on the best timing and treatment (surgical and radiotherapeutic) of the axilla for patients with early-stage breast cancer. METHODS: Ontario Health (Cancer Care Ontario) and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. RESULTS: This guideline endorsed two recommendations of the ASCO 2017 guideline for the use of sentinel lymph node biopsy in patients with early-stage breast cancer and expanded on that guideline with recommendations for radiotherapy interventions, timing of staging after neoadjuvant chemotherapy (NAC), and mapping modalities. Overall, the ASCO 2017 guideline, seven high-quality systematic reviews, 54 unique studies, and 65 corollary trials formed the evidentiary basis of this guideline. RECOMMENDATIONS: Recommendations are issued for each of the objectives of this guideline: (1) To determine which patients with early-stage breast cancer require axillary staging, (2) to determine whether any further axillary treatment is indicated for women with early-stage breast cancer who did not receive NAC and are sentinel lymph node-negative at diagnosis, (3) to determine which axillary strategy is indicated for women with early-stage breast cancer who did not receive NAC and are pathologically sentinel lymph node-positive at diagnosis (after a clinically node-negative presentation), (4) to determine what axillary treatment is indicated and what the best timing of axillary treatment for women with early-stage breast cancer is when NAC is used, and (5) to determine which are the best methods for identifying sentinel nodes.Additional information is available at www.asco.org/breast-cancer-guidelines.

A systematic review of yoga for state anxiety: considerations for occupational therapy.

BACKGROUND: State anxiety can result from a variety of life situations. This type of anxiety can disrupt occupational engagement and performance, thereby affecting rehabilitation and recovery. Occupational therapists need to address the connection between mind-body-spirit and its relationship to performance and engagement in meaningful occupations. Yoga, when used as an adjunct to therapy, has the potential to address state anxiety. PURPOSE: The aim was to systematically review the evidence concerning the effectiveness of yoga as a treatment approach for state anxiety. METHODS: Six electronic databases, the authors' own files, and the references of included studies from 1990 to July 2011 were searched. FINDINGS: A total of 25 unique studies represented by 26 publications made up the sample: two systematic reviews; 16 randomized controlled trials, and seven prospective, controlled, non-randomized studies. Evidence suggests yoga can be a viable therapeutic option for reducing state anxiety in certain situations. IMPLICATIONS: In making the determination to recommend yoga as an intervention, occupational therapists should consider the client's circumstances and values as well as the type and intensity of the yoga program.

Effect of coronary artery bypass graft surgery on older women's health-related quality of life.

OBJECTIVE: The purpose of this study was to determine if health-related quality of life (HRQL) improves after coronary artery bypass graft (CABG) surgery in older women. DESIGN: The study design was longitudinal observational. SETTING: The study took place in a tertiary-care teaching hospital in Hamilton, Ontario, Canada. PATIENTS: Study participants included 34 women 61 years or older who had elective or urgent CABG surgery for the first time. OUTSOME MEASURES: The 2 measures of HRQL were the Medical Outcomes Study Short Form-36 and the Feeling Thermometer (FT). The Short Form-36 is composed of 8 subscales that are summarized into the Physical and the Mental Composite Scores. The FT is a utility measure that rates patients' preferences for different health states. RESULTS: HRQL of older women was improved after CABG surgery: 7.79 points in the physical composite scores (P = .001), 7.26 in the mental composite scores (P = .008), and 29.77 points in the FT scores (P < .001). Age was a predictor of HRQL, with older women demonstrating poorer physical and better mental HRQL 3 months after the operation. CONCLUSIONS: HRQL of older women is improved significantly as early as 3 months after CABG surgery.