Overdiagnosis and Overtreatment of Breast Cancer: How Can We Promote Informed Patient Choice?

2013 ◽  
Vol 5 (4) ◽  
pp. 263-265
Author(s):  
Elissa M. Ozanne
Keyword(s):  
Breast Cancer ◽  
Patient Choice ◽  
Informed Patient

Quality prescribing in early psychosis: key pharmacotherapy principles

2021 ◽  
pp. 103985622110546
Author(s):  
James G Scott ◽  
Gemma McKeon ◽  
Eva Malacova ◽  
Jackie Curtis ◽  
Bjorn Burgher ◽  
...  
Keyword(s):  
Patient Choice ◽  
Early Psychosis ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Metabolic Monitoring ◽  
Risk Benefit Assessment ◽  
Medication Risk ◽  
Long Acting ◽  
Informed Patient ◽  
Medication Choice

Objective: To present a practical, easy-to-implement clinical framework designed to support evidence-based quality prescribing for people with early psychosis. Method: Identification and explanation of key principles relating to evidence-based pharmacotherapy for people with early psychosis. These were derived from the literature, practice guidelines and clinical experience. Results: Key principles include (1) medication choice informed by adverse effects; (2) metabolic monitoring at baseline and at regular intervals; (3) comprehensive and regular medication risk–benefit assessment and psychoeducation; (4) early consideration of long-acting injectable formulations (preferably driven by informed patient choice); (5) identification and treatment of comorbid mood disorders and (6) early consideration of clozapine when treatment refractory criteria are met. Conclusions: Current prescribing practices do not align with the well-established evidence for quality pharmacotherapy in early psychosis. Adopting evidence-based prescribing practices for people with early psychosis will improve outcomes.

Informed patient choice is the priority for C-sections

2010 ◽  
Vol 25 (13) ◽  
pp. 33-33
Author(s):  
Becky Muckle
Keyword(s):  
Patient Choice ◽  
Informed Patient

Breast cancer risk reduction among patients with DCIS.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1562-1562
Author(s):  
Melanie R. Palomares ◽  
Michelle Banzet ◽  
Kelley Lu ◽  
Jacob Justus ◽  
Rebecca A Ottesen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Reduction ◽  
Ductal Carcinoma ◽  
Invasive Disease ◽  
Mammographic Screening ◽  
Patient Choice ◽  
Age Bias ◽  
Treatment Choices ◽  
Younger Age ◽  
Cancer Network

1562 Background: The incidence of ductal carcinoma in situ (DCIS) has dramatically increased with widespread mammographic screening. Although risk of recurrence of DCIS is low, it is associated with a higher risk for subsequent contralateral breast cancer (CBC), for which preventive measures are available. We evaluated the uptake of surgical and pharmacologic interventions to reduce CBC risk at our institution and investigated factors that may influence treatment choices for DCIS. Methods: City of Hope (COH) DCIS patients were identified using two sources, the Circulating Breast Tumor Marker (BrTM) Registry and the National Comprehensive Cancer Network (NCCN) database. Datasets were linked together, and treatment variables were cross-tabulated with patient and tumor characteristics. Results: Of 782 patients with breast malignancy diagnosed since 1997, 370 were excluded due to concurrent or prior invasive disease, 8 due to suspected misclassification based on therapies received, and 4 due to treatment on protocol. Of the remaining pure DCIS patients, treatment choices were recorded for 289. Of those, 40 (14%) chose bilateral risk reduction mastectomy (BRRM), 82 (28%) unilateral mastectomy, 165 (57%) lumpectomy, and 2 had no surgery. Hormonal therapy (HT) was recorded for 215 individuals who did not pursue BRRM: 124 (57%) took tamoxifen, 3 of whom switched to raloxifene, 5 (2%) started with raloxifene, and 7 (3%) took an unspecified hormonal agent, for a total HT uptake of 55%. This included 8 of 29 women with ER-negative DCIS who chose HT for CBC risk reduction. Younger age at diagnosis was associated with BRRM (24% of women diagnosed before age 50, 10% of those diagnosed 50-64, and 5% of women 65+ had BRRM, p<0.001) and HT (59% of women <65 chose HT compared to 40% of women 65+, p=0.009). Within ethnic minorities, more Asian women chose BRRM (22% vs 7% of other minorities, p=0.08). Interestingly, fewer high grade DCIS women opted for HT (39% vs 55% for low to intermediate grade, p=0.06). Conclusions: Young women tend to pursue surgical prophylaxis. Among women who keep their breasts, HT uptake was high across all age and ethnic groups, except for those older than 65 at diagnosis. It is unclear if this is due to patient choice or reflects age bias in physician recommendation.

The quality of breast cancer quality measures.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 108-108
Author(s):  
Whitney Lane ◽  
Christel Rushing ◽  
Daniel Nussbaum ◽  
Dan G. Blazer ◽  
Rachel Adams Greenup
Keyword(s):  
Breast Cancer ◽  
Patient Preference ◽  
Cancer Care ◽  
Performance Metrics ◽  
Prophylactic Mastectomy ◽  
Patient Choice ◽  
Breast Cancer Care ◽  
Cancer Data ◽  
Breast Care

108 Background: To assess quality in breast cancer care, standardized metrics are needed. Many accepted breast performance metrics are based on evidence-based practice; however, most fail to reflect patient choice in treatment decisions. Given the focus on patient-centered breast care, we sought to determine how compliance with established quality metrics correlates with receipt of breast cancer care impacted by patient preference. Methods: American College of Surgeons (ACS) National Cancer Data Base facilities were designated compliant or non-compliant based on Commission of Cancer (CoC) breast metrics MASTRT, BCSRT and HT*, which all improve survival. Compliant facilities met the expected performance rate (EPR) for all three metrics, while non-compliant facilities failed to meet the EPR for any. Rates of breast conserving surgery (BCS) for early stage cancer, immediate breast reconstruction (IBR), and contralateral prophylactic mastectomy (CPM) are proposed metrics that are impacted by patient preference. For these, quality is defined as high rates of BCS, high rates of IBR, and low rates of CPM. Multivariable logistic regression models were used to estimate the association between facility level rates on these measures and the probability of treatment at a CoC compliant facility. Results: 729 facilities were included in the analysis. Based on the CoC measures, 79 (10.8%) were considered compliant and 650 (89.2%) non-compliant. Rates of BCS and IBR did not differ between compliant and non-compliant facilities; however, women treated at compliant facilities were more likely to undergo CPM (26.3% vs 21.4%; p = 0.02). In a multivariate model treatment at compliant facilities was associated with higher rates of BCS, IBR, and CPM; however, the predictive value of these metrics was minimal (Estimated OR range: 1.01-1.03). Conclusions: Rates of preference driven therapies do not differentiate CoC compliant and non-compliant hospitals. The quality of a hospital’s breast care is likely poorly measured by metrics that are influenced by, but cannot account for patient values. *MASTRT (RT≤1yr of diagnosis in women with ≥4 +lymph nodes); BCSRT (RT ≤1yr of diagnosis for women ≤70 receiving BCS); HT (hormone therapy recommended ≤1yr of diagnosis for HR-positive breast cancer)

Breast cancer treatment and recurrence in octogenarians.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 94-94
Author(s):  
Adam Harris ◽  
Sarah A. McLaughlin ◽  
Cameron Adkisson ◽  
Sanjay Prakash Bagaria ◽  
Tammeza Gibson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Hormonal Therapy ◽  
Treatment Guidelines ◽  
Disease Risk ◽  
Low Risk ◽  
Patient Choice ◽  
High Risk Disease ◽  
Er Positive ◽  
Risk Patients

94 Background: Octogenarian breast cancer (BrCa) patients accept less aggressive BrCa treatment due to decreased life expectancy, increased comorbidities, and high likelihood of death from other causes. Unfortunately little data exist stratifying octogenarian outcomes by disease risk. We sought to characterize treatment and recurrence patterns in patients >80yo. Methods: Retrospective review identified 432 women >80yo treated surgically for stage 0-3 BrCa between 11/99-8/11. We gathered clinicopathologic data and classified patients by disease risk as DCIS only, low risk (<2cm and ER positive and node negative), or high risk (>2cm or ER negative or node positive). We compared recurrence rates and estimated survival by Kaplan-Meier curves. Results: Among the 432 women, disease was found by mammogram in 86%, treated with BCT in 64%, and predominantly ER-positive (87%). We classified patients as having DCIS only (N=61), low risk (N=205), or high risk (N=166) disease. We identified the following deviations from standard treatment guidelines: 68% DCIS BCT and 38% high risk BCT patients did not have radiation therapy, 25% low risk BCT patients had surgery only, 51% low risk patients did not take adjuvant hormonal therapy, and 40% high risk patients had no adjuvant chemo/hormonal therapy. At 5 and 10 years the overall estimated survival was 63% and 31%, respectively. Overall, 19/432 (5%) patients developed recurrence (table 1). Patients needing mastectomy for high risk disease had significantly higher risk of recurrence than high or low risk BCT patients (p=0.02). Of the 19 recurrence patients, 7/19 (37%; 1 DCIS, 1 low risk, 5 high risk) occurred despite standard multimodality treatment, while12 (63%; 3 low risk, 9 high risk) had the initial tumor treated less aggressively due to patient choice (n=9) or medical co-morbidities (n=3). Conclusions: Significant deviations from treatment guidelines occur in women >80yo. Those with high risk disease should be counseled accordingly and encouraged to receive adjuvant treatment as two thirds of women >80yo will live at least 5 years. [Table: see text]

Evidence-Informed Patient Choice: Practical Issues of Involving Patients in Decisions About Health Care Technologies

1998 ◽  
Vol 14 (2) ◽  
pp. 212-225 ◽  
Author(s):  
Vikki A. Entwistle ◽  
Trevor A. Sheldon ◽  
Amanda Sowden ◽  
Ian S. Watt
Keyword(s):  
Health Care ◽  
Patient Choice ◽  
Health Care Options ◽  
Informed Patient ◽  
Health Care Technologies

AbstractEvidence-informed patient choice involves providing people with research-based information about the effectiveness of health care options and promoting their involvement in decisions about their treatment. Although the concept seems desirable, the processes and outcomes of evidence-informed patient choice are poorly understood, and it should be carefully evaluated.

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