Predictors of adverse cosmetic outcome in the RAPID trial: an exploratory analysis.

PURPOSE: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. METHODS AND MATERIALS: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. RESULTS: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. CONCLUSION: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment volume was not independently associated with an adverse cosmetic outcome, and a useful clinical threshold could not be identified.

Screening-detected non-symptomatic breast cancer: a case history.

Alice is a 65 year-old woman who was recalled for further investigations following a routine screening mammogram, which showed a 25 mm mass in her left breast. This case history will report on the further investigations and surgery required to manage this infiltrating ductal carcinoma. The histopathology report will be analysed to provide a rationale for future treatment with radiotherapy, and Alice's expected prognosis will be presented using the Nottingham Prognostic Index. Alice's psychological support needs will identified and the appropriate interventions will be discussed with a particular focus on Alice's history of depression. The supportive and educational role of the breast care nurse and the multidisciplinary team will be highlighted throughout the study.

Sexuality and body image concerns after treatment for breast cancer.

A mastectomy left this patient with sexual problems and an altered sense of femininity. Communication models exist that can facilitate nurse-patient conversations about sexuality.

Menopausal symptoms following tamoxifen treatment for breast cancer.

Hot flashes negatively impacted the patient's mood, stress level, sleep, and relationship with her husband. Breathing exercises and pharmacological management with a low-dose antidepressant alleviated the problem.

Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template.

PURPOSE/OBJECTIVES: To describe two templates that can be used to improve the quality of breast cancer treatment decisions. DATA SOURCES: Case study, survey of current users, three clinical trials. FINDINGS: Clinical applications of the Consultation Planning Template and Consultation Recording Template vary across organizations. Clinical trials have demonstrated that the templates can improve the quality of decisions, the quality of communication between patients and providers, and satisfaction. CONCLUSIONS: The templates can be adapted to different clinical settings and can improve the quality of treatment decisions. IMPLICATIONS FOR NURSING: Nurses often provide the majority of education and coaching for patients making decisions. As patients' demands for involvement in decision making increase, nurses need practical tools to help patients participate. The templates are practical tools that nurses can use to help patients make better decisions.

Understanding patients' needs is the foundation of perioperative nursing.

As I reflected on Mrs L's procedure, I realized the importance of my role. I coordinated the efforts of the radiologist, radiological technologist, surgeon, pathologist, and nurses to provide Mrs L with a positive surgical experience, and I collaborated with Mrs L and her husband to make them as comfortable and relaxed as possible. I connected with Mrs L and her husband--they knew I would help them in any way to make this a positive experience. In addition, I collected data about Mrs L's perception and satisfaction with her experience to explore her response to her stereotactic surgical biopsy procedure experience. Perioperative nurses are important to patients and their family members. By listening to patients' needs, planning for their individual care, and being present, perioperative nurses help patients through difficult situations. I use my experience and knowledge to serve as a role model for breast imaging personnel, nurses, and other coworkers, and to improve each patient's perioperative experience.

New instrumentation allows for removal of nonpalpable breast lesions.

Breast cancer is the second leading cause of cancer deaths in women. Approximately 90% of breast cancer is curable if it is diagnosed and treated early. Increasingly, women are participating in mammographic screenings, which result in earlier detection of nonpalpable lesions. In the past, surgical removal was not an option for small lesions, and frequent mammographic monitoring was required until patients' lesions were large enough for needle core biopsies or needle localization for open surgical biopsies. Technology now has combined stereotactic imaging with a minimally invasive biopsy system for removal of these nonpalpable lesions. This capability for accurate early diagnosis and intervention is essential in improving patients' survival rates.