Self-assessment of a breast care nursing model within a Breast Unit: learning process and keys to improving breast care.

AIM AND OBJECTIVES: To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators. BACKGROUND: Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care. DESIGN: Cohort study. METHODS: Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study. RESULTS: We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines. CONCLUSION: The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond completion of primary treatment. RELEVANCE TO CLINICAL PRACTICE: This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care. PATIENT OR PUBLIC CONTRIBUTION: No contribution from the patient or the public because the data collected was entered into the clinical history by the health professionals of the Breast Unit as part of their usual clinical practice.

Effect of frailty on postoperative complications, mortality, and survival in older patients with non-metastatic colon cancer: A systematic review and meta-analysis.

INTRODUCTION: New evidence has emerged on the impact of frailty on prognosis in colon cancer, but the findings are not always consistent and conclusive. The aim of this systematic review was to assess the effect of frailty on postoperative complications and mortality in patients with non-metastatic colon cancer (CC) aged 65 years and older. MATERIALS AND METHODS: We systematically searched for original studies published in the PubMed and Web of Science databases up to June 2021. Two independent reviewers selected the studies and extracted predefined data. A meta-analysis was performed using the random effects model to assess the effect of frailty on 30-day, 3- to 6-month and 1-year mortality, survival, and postoperative complications. RESULTS: The search yielded 313 articles, of which 14 were included in this systematic review. The meta-analysis showed an effect for frailty on 30-day, 3- to 6-month, and 1-year mortality with respective pooled odds ratios (ORs) of 3.67 (95% confidence interval [CI] 1.53-8.79, p = 0.004), 8.73 (95% CI 4.03-18.94, p < 0.0001), and 3.99 (95% CI 2.12-7.52, p < 0.0001). Frailty also had an effect on survival, with a pooled hazard ratio of 2.99 (95% CI 1.70-5.25. p < 0.0001), and on overall and severe postoperative complications with pooled ORs of 2.34 (95% CI 1.75-3.15; p < 0.0001) and 2.43 (95% CI 1.72-3.43; p < 0.0001), respectively. DISCUSSION: Frailty in older patients with CC is a risk factor for postoperative complications and mortality in the short term (30 days), medium term (3-6 months), and long term (1 year).

[Effect of frailty in health resource use in aged cancer patients]. / Efecto de la fragilidad en el consumo de recursos sanitarios en ancianos con cáncer.

OBJECTIVE: To evaluate the effect of frailty on health resource use in aged population with cancer. METHOD: Population-based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people ≥65 years with cancer. RESULTS: Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p=0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). CONCLUSIONS: Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer.

Efecto de la fragilidad en el consumo de recursos sanitarios en ancianos con cáncer / Effect of frailty in health resource use in aged cancer patients

Objetivo Evaluar el efecto de la fragilidad en el consumo de recursos sanitarios en población anciana con cáncer. Método Estudio de cohortes de base poblacional con recogida retrospectiva y seguimiento de enero de 2018 a diciembre de 2019 en personas ≥65 años con cáncer. Resultados Se incluyeron 996 sujetos, con una prevalencia de fragilidad del 22,1%. La mortalidad a los 2 años fue del 14,1% en los frágiles y del 9,0% en los no frágiles (p = 0,028). Independientemente de la edad y del sexo, la fragilidad aumentó el número de hospitalizaciones urgentes (168%) y programadas (64%), las visitas a urgencias (111%), las consultas externas (59%), las sesiones de hospital de día (30%) y las visitas a atención primaria (114%). Conclusiones La fragilidad es más prevalente, condiciona un peor pronóstico y se asocia a un mayor consumo de recursos sanitarios en los ancianos con cáncer. (AU)

Objective To evaluate the effect of frailty on health resource use in aged population with cancer. Method Population-based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people ≥65 years with cancer. Results Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p = 0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). Conclusions Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer. (AU)

Core communication components along the cancer care process: the perspective of breast cancer patients.

This study sought to assess the impact of health care professional (HCP) communication on breast cancer patients across the acute care process as perceived by patients. Methodological approach was based on eight focus groups conducted with a sample of patients (n = 37) drawn from 15 Spanish Regions; thematic analysis was undertaken using the National Cancer Institute (NCI) framework of HCP communication as the theoretical basis. Relevant results of this study were the identification of four main communication components: (1) reassurance in coping with uncertainty after symptom detection and prompt access until confirmed diagnosis; (2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues; (3) guidance on the different therapeutic options, through use of clinical scenarios; and, (4) eliciting the feeling of emotional exhaustion after ending treatments and addressing the management of potential treatment-related effects. These communication-related components highlighted the need for a comprehensive approach in this area of cancer care.

Health status and health resource use among long-term survivors of breast, colorectal and prostate cancer.

INTRODUCTION: The growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors' health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services. METHODS: Retrospective multicenter cohort study. We collected data from patients' clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales. RESULTS: The questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital. CONCLUSIONS: Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain.

[The growing snowball in health services: long-term cancer survivors]. / Una bola de nieve está creciendo en los servicios sanitarios: los pacientes supervivientes de cáncer.

One of the consequences of diagnostic and therapeutic progress in cancer is the increased survival observed in the last few decades in Spain and elsewhere in Europe. New cancer cases are increasing steadily due to population aging, among other factors. Consequently, the number of long-term survivors can be expected to increase in the years to come. This increase will tax healthcare systems, which are already showing the limitations of the present model of follow-up. New scenarios should be assessed and proposed from both the management and clinical perspectives. Although there is insufficient scientific evidence to indicate the most effective way to organize the follow-up of these patients, several approaches are being proposed in other countries to improve the fit between health services provision and the specific needs of these patients. In Spain, these experiences are scarce. However, given the situation, which could be described as a snowball effect, the current model should be reviewed and new approaches discussed in order to provide a more effective response to this situation. This article aims to identify the priorities for cancer survivors from the healthcare point of view, to review organizational approaches in other countries, and to propose a framework, based on the integration of the different levels of health care, including primary care - the Cinderella of this situation - in order to assess various healthcare options for these patients in the Spanish healthcare context.

Health status and health resource use among long-term survivors of breast, colorectal and prostate cancer / Estado de salud y uso de recursos sanitarios en largos supervivientes de cáncer de mama, colorectal y próstata

Introduction: The growing number of long-term cancer survivors poses a new challenge to health care systems. In Spain, follow-up is usually carried out in oncology services, but knowledge of cancer survivors’ health care needs in this context is limited. The purpose of this study was to ascertain the health status of long-term survivors of breast, prostate, and colorectal cancer and to characterize their use of health care services. Methods Retrospective multicenter cohort study. We collected data from patients’ clinical histories and through telephone interviews, using a specially designed questionnaire that included the SF-36v2 Quality of Life and Nottingham Health Profile scales. Results The questionnaire was completed by 51.2% (n= 583) of the potential sample. No significant differences were observed between 5-year and 10-year survivors. Overall, more than 80% of respondents were undergoing drug treatment for morbidity related to advanced age. Quality of life was good in most patients, and cancer-related morbidity was low and of little complexity. For the most part, participants reported using primary care services for care of chronic diseases and opportunistic treatment of sequelae related to the cancer treatment. Oncological follow-up was centralized at the hospital. Conclusions Survivors of breast, prostate and colorectal cancer with tumoral detection at an early stage and without recurrences or second neoplasms experienced little morbidity and enjoyed good quality of life. This study proposes exploration of a follow-up model in the Spanish health system in which primary care plays a more important role than is customary in cancer survivors in Spain (AU)

Introducción: El creciente número de supervivientes de larga evolución de cáncer es un nuevo reto para los sistemas sanitarios. En España, su seguimiento se desarrolla principalmente en los servicios oncológicos y el conocimiento actual sobre sus necesidades sanitarias es en este contexto limitado. El objetivo de este estudio es conocer el estado de salud de los supervivientes de larga evolución en los tumores de mama, próstata y colorrectal y caracterizar el uso de los recursos sanitarios que éstos realizan. Métodos Estudio multicéntrico de cohortes retrospectivo. Se recogió la información de la historia clínica y de entrevista telefónica a los pacientes mediante un cuestionario específico que incluyó los de calidad de vida SF-36v2 y Perfil de Salud de Nottingham. Resultados Respondieron el 51.2% (583) de la muestra potencial. No se observaron diferencias significativas entre los supervivientes entre 5 y 10 años. En conjunto, más del 80% seguían tratamiento farmacológico debido a la morbilidad relacionada con la edad avanzada. La mayoría tenía buena calidad de vida y la morbilidad asociada al cáncer fue reducida y de baja complejidad. Mayoritariamente frecuentan atención primaria para las patologías crónicas y de forma oportunista para las secuelas relacionadas con el tratamiento de cáncer. El seguimiento oncológico está centralizado en el hospital. Conclusiones Los supervivientes de cáncer de mama, próstata y colorrectal diagnosticados en estadios tempranos, que no han tenido recurrencia ni segundas neoplasias, presentan limitada morbilidad y tienen buena calidad de vida. Este estudio propone explorar en nuestro sistema sanitario un modelo de seguimiento donde la atención primaria tenga un rol más relevante que el actual para la atención de los supervivientes de cáncer en España (AU)

Una bola de nieve está creciendo en los servicios sanitarios: los pacientes supervivientes de cáncer / The growing snowball in health services: long-term cancer survivors

Una de las consecuencias del progreso en el diagnóstico y el tratamiento del cáncer es el aumento de la supervivencia observado en las últimas décadas en Europa y en España. El número de nuevos casos de cáncer continúa aumentando principalmente debido al envejecimiento de la población, por lo que es previsible que el número de personas que viven años tras un diagnóstico de cáncer continúe creciendo. Este hecho supone un elemento de presión a los sistemas sanitarios, que muestran sus limitaciones para atenderlos con el modelo actual de seguimiento. Deben plantearse nuevos escenarios asistenciales, tanto desde la perspectiva de la gestión sanitaria como de la clínica. A pesar de no haber suficiente evidencia científica sobre cómo sistematizar el seguimiento de los casos, se están impulsando diversas estrategias, sobre todo en otros países, para lograr una mayor adecuación en la provisión de servicios a estos pacientes. En España tales experiencias son muy escasas, pero dada la situación emergente, que bien puede ser comparada a un efecto en bola de nieve, se requiere la revisión y la reformulación del modelo actual para ofrecer una respuesta más efectiva y ajustada a la realidad. El propósito de este artículo es identificar las prioridades de atención de estos pacientes desde el punto de vista sanitario, revisar los modelos organizativos que se ensayan en otros países y proponer un marco de referencia, basado en la integración de niveles asistenciales, incluyendo atención primaria de la salud, que es la Cenicienta en este problema, como aproximación a un modelo que permita evaluar las mejores opciones asistenciales para estos pacientes en nuestro entorno sanitario (AU)

One of the consequences of diagnostic and therapeutic progress in cancer is the increased survival observed in the last few decades in Spain and elsewhere in Europe. New cancer cases are increasing steadily due to population aging, among other factors. Consequently, the number of long-term survivors can be expected to increase in the years to come. This increase will tax healthcare systems, which are already showing the limitations of the present model of follow-up. New scenarios should be assessed and proposed from both the management and clinical perspectives. Although there is insufficient scientific evidence to indicate the most effective way to organize the follow-up of these patients, several approaches are being proposed in other countries to improve the fit between health services provision and the specific needs of these patients. In Spain, these experiences are scarce. However, given the situation, which could be described as a snowball effect, the current model should be reviewed and new approaches discussed in order to provide a more effective response to this situation. This article aims to identify the priorities for cancer survivors from the healthcare point of view, to review organizational approaches in other countries, and to propose a framework, based on the integration of the different levels of health care, including primary care – the Cinderella of this situation – in order to assess various healthcare options for these patients in the Spanish healthcare context (AU)