Treatment recommendations for older women with breast cancer: A survey among surgical, radiation and medical oncologists.

PURPOSE: As older women with breast cancer (BC) are underrepresented in trials, it is often unclear what represents the best treatment option for this patient group. To understand how oncologists approach the management of BC in older patients, we assessed their treatment recommendations. METHODS: In an online survey, 106 surgical, 37 radiation and 31 medical oncologists provided a treatment recommendation for hypothetical patients aged >70 years. Scenarios included loco-regional therapy with patient age varying at 76 and 84 years; systemic therapy with Karnofsky performance score varying at 90 and 50%; neo-adjuvant therapy; and adjuvant chemotherapy in triple-negative BC. RESULTS: Participants would less often recommend breast-conserving surgery plus radiotherapy for an 84 versus a 76-year-old patient (56% versus 73%, p = 0.001). They would more often accept omission of radiotherapy after breast-conserving surgery in older than in younger patients, if the patient wished to avoid this therapy (26% versus 4%, p < 0.001). All participants would propose systemic therapy for a high-recurrence risk patient with a good performance score, and 92% would still recommend therapy if the patient had a poor score (p < 0.001). Neo-adjuvant hormonal therapy followed by breast-conserving surgery for a large tumour was recommended by 27% of the participants. Adjuvant chemotherapy for an otherwise healthy woman with triple-negative BC was considered by 83% of the participants. CONCLUSIONS: Patient age and performance status influenced specialists' treatment recommendations. The observed recommendations for the treatment scenarios under investigation differ from older women's actual treatment. This discrepancy highlights the need for studies specifically targeting older patients.

Daily consumption of foods and nutrients from institutional and home sources among young children attending two contrasting day-care centers in Guatemala City

Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement children’s diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.

Ingesta diaria de alimentos y nutrientes provenientes de la dieta institucional y del hogar en niños que asisten a dos centros de cuidado infantil contrastantes en la ciudad de Guatemala. Una adecuada nutrición es crítica para el desarrollo infantil. Los centros de cuidado infantiles (CCI) podrían jugar un papel fundamental en la complementación de la ingesta de alimentos y nutrientes. El propósito de este estudio fue describir la dieta de niños, comparando la contribución relativa de energía y nutrientes de la dieta-hogar e institucional. El presente estudio debe ser considerado como una presentación de caso. Se examinó la dieta de 33 niños de 3-6 años que asisten a dos CCI utilizados por familias de escasos recursos y con diferencias en número de comidas servidas. Se determinó la dieta-hogar utilizando 3 recordatorios de 24-horas en días no-consecutivos. Se calculó la ingesta estimada de energía y nutrientes en las instituciones y en casa y se comparó con las Ingestas Recomendadas de Nutrientes. Se determinó la densidad de nutrientes y principales fuentes. Se observó que los alimentos consumidos en el hogar contribuyeron 47.7% de la energía diaria y entre 29.9% y 53.5% de los nutrientes diarios requeridos para los niños con 3 comidas en el CCI y de 83.9%, 59.0 y 94.8%, respectivamente, para los niños que consumen únicamente el almuerzo en el CCI. La ingesta diaria de energía fue 304 kcal mayor en los niños que consumieron 3 comidas fuera del hogar. No hubo mayor variación en las dietas cuando mayor era el consumo de alimentos en el hogar, sin embargo la densidad nutricional y la adecuación de la dieta completa fue adecuada en ambos centros, y particularmente elevadas para la vitamina A.

Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands.

BACKGROUND: The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equal. METHODS: Female breast cancer patients diagnosed between 1994 and 2008 were selected from the nationwide population-based Netherlands Cancer Registry (N=176 505). Socioeconomic status was assessed based on income, employment and education at postal code level. Multivariable models included age, year of diagnosis and stage. RESULTS: Sentinal node biopsy was less often applied in high-SES patients (multivariable analyses, ≤ 49 years: odds ratio (OR) 0.70 (95% CI: 0.56-0.89); 50-75 years: 0.85 (0.73-0.99)). Additionally, lymph node dissection was less common in low-SES patients aged ≥ 76 years (OR 1.34 (0.95-1.89)). Socioeconomic status-related differences in treatment were only significant in the age group 50-75 years. High-SES women with stage T1-2 were more likely to undergo breast-conserving surgery (+radiotherapy) (OR 1.15 (1.09-1.22) and OR 1.16 (1.09-1.22), respectively). Chemotherapy use among node-positive patients was higher in the high-SES group, but was not significant in multivariable analysis. Hormonal therapy was not related to SES. CONCLUSION: Small but significant differences were observed in the use of SNB, lymph node dissection and breast-conserving surgery according to SES in Dutch breast cancer patients despite assumed equal access to health care.

Daily consumption of foods and nutrients from institutional and home sources among young children attending two contrasting day-care centers in Guatemala City.

Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement children's diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.