Regularly scheduled physical examinations and the detection of breast cancer recurrences.

PURPOSE: Follow-up care of early breast cancer (EBC) patients usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, little evidence supports this schedule. We evaluated recurrence detection of patients transferred into a single centre survivorship program that follows ASCO recommendations. METHODS: Patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) who had breast cancer recurrence between February 1, 2013, and January 1, 2019 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection. RESULTS: Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral breast primaries (14.6%). Distant recurrences were primarily detected via patient-reported symptoms (125/135, 92.6%). 53.7% (22/41) of ipsilateral breast recurrences were detected by patients and 41.5% (17/41) by routine imaging. Contralateral breast primaries were primarily detected by imaging 83.3% (25/30) and patient-reported symptoms 16.7% (5/30). Only 2/206 (1.14%) recurrences/new primaries were detected by healthcare providers at routinely scheduled follow-up visits. CONCLUSIONS: Despite following ASCO guidelines, healthcare providers rarely detect recurrences at routinely scheduled follow-up appointments. Our data suggests that approximately 35, 000 follow-up visits were required for healthcare providers to detect these 2 recurrences. While reduced in-person visits may affect other aspects of follow-up care (e.g. toxicity management), it appears unlikely, provided patients attend regular screening tests, that less frequent in-person follow-up is associated with worse breast cancer-related outcomes.

Standardized versus personalized survivorship care plans for breast cancer survivors: A program evaluation.

The Wellness Beyond Cancer Program provides survivorship care plans (SCPs) to cancer survivors, as they transition from cancer centres back to their primary care provider (PCP) upon treatment completion. A program evaluation examined whether standardized SCPs resulted in comparable outcomes on perceived knowledge and patient activation as personalized SCPs. Breast cancer survivors who received either standardized or personalized SCPs completed pre- and post-surveys during their discharge appointment, which included an in-house measure on perceived knowledge, The Perceived Efficacy in Patient-Physician Interactions, and The Patient Activation Measure. Eighty-seven breast cancer survivors completed the surveys (personalized SCP n = 43; standardized SCP n = 44). Standardized SCPs resulted in comparable knowledge and activation outcomes as personalized SCPs. Cost-efficient standardized SCPs may help alleviate human resource constraints and may be considered for further evaluation and implementation in cancer centres.

Early and midterm results after coronary artery bypass grafting with and without cardiopulmonary bypass: which patient population benefits the most?

BACKGROUND: We present our early and midterm results with off-pump coronary artery bypass grafting (OPCAB) on the beating heart and with conventional coronary artery bypass grafting (CABG) and compare patient outcomes for both procedures. METHODS: Between November 1997 and April 2001, OPCAB was performed in 330 patients. The results were compared with those of a matched population of 330 patients who had undergone CABG during the same period. Specific postoperative outcomes were evaluated for patient subgroups with multimorbidity, with impaired ventricular function, of an older age, and of a young age without comorbidities. Midterm results and quality-of-life (QOL) scores for patients were obtained by follow-up. RESULTS: In the overall series, OPCAB resulted in signifi- cantly shorter surgery times (P =.008), ventilation times (P <.001), intensive care unit (ICU) stays (P <.001), and hospital stays (P =.006). OPCAB also resulted in less postoperative inotropic medication (P =.041), lower transfusion rates (P <.001), fewer postoperative myocardial infarctions (P =.038), and lower hospital mortality rates (P =.024). Among the patient subgroups, patients with multimorbidities were the only subgroup to show a significant reduction in hospital mortality after OPCAB surgery (P =.048). Times of postoperative ventilation, ICU stay, and hospitalization were significantly reduced for all patient subgroups (P <.05). After mean followup times of 43.8 months (OPCAB) and 44.8 months (CABG), QOL scores, midterm complication rates, and mortality rates were not significantly different among the groups. CONCLUSION: OPCAB surgery improved postoperative recovery for the entire patient population without compromising midterm outcome. Compared with conventional CABG, high-risk patients with multimorbidity particularly profit from avoiding cardiopulmonary bypass and show significantly lower hospital mortality.

Midterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy.

BACKGROUND: Off-pump cardiac surgery is becoming an established method of surgical revascularization. However, performing anastomoses on a beating heart can be challenging, especially through small incisions. We compared our midterm results in patients with 1 vessel disease using full sternotomy (OPCAB) or a left anterior minithoracotomy (MIDCAB). METHODS: At our institution between December 1996 and December 1998, 102 patients (OPCAB, n = 45, MIDCAB, n = 57); age, 61 +/- 11 years; 69% men with 1-vessel disease of the left anterior descending coronary artery (LAD) underwent off-pump myocardial revascularization through the left internal thoracic artery (LITA). In the OPCAB group 17 (37.8%) of the patients received an additional vein graft to a diagonal branch. OPCAB was generally preferred in obese or high-risk patients or patients with a long LITA-LAD distance (>7 cm) on an electron beam computed tomography of the chest. RESULTS: Operative mortality was 0. Time of surgery (169 +/- 48 versus 197 +/- 45 minutes) and coronary artery occlusion time (19 +/- 7 versus 23 +/- 6 minutes) were significantly lower (P = .004 and P = .009) in the OPCAB group. MIDCAB surgery was related to a higher incidence of occluded (4 versus 0; P = .039) or stenosed (7 versus 2; P = .06) anastomoses and necessity for immediate reintervention (9 versus 0; P = .023). During a mean follow-up period of 5.2 years, MIDCAB patients (6 MIDCAB patients versus 1 OPCAB patient) tended to need more coronary interventions and develop more recurrent angina (23 MIDCAB versus 12 OPCAB patients). Two OPCAB patients died during the follow-up period. CONCLUSIONS: Our initial experience in beating heart surgery demonstrated that MIDCAB is technically more challenging than OPCAB. MIDCAB procedures should therefore be performed by experienced surgeons on selected patients. Midterm results after OPCAB procedures tend to a lower rate of adverse cardiac events.