Karen K. Swenson

Quality of life after breast carcinoma surgery: a comparison of three surgical procedures.

Because breast‐conserving surgery (BCS), mastectomy alone, and mastectomy with reconstruction are equally effective for the treatment of early stage breast carcinoma, womens choice among them often focuses on quality‐of‐life (QOL) issues. Information regarding QOL after these surgical treatments could help women with this decision.

Subareolar injection of99mTc facilitates sentinel lymph node identification

Background: Sentinel lymph node (SLN) biopsy with the standard intraparenchymal injection has been accepted as an alternative to routine axillary dissection for patients with breast cancer. However, the identification and false-negative rates with this method can vary widely from surgeon to surgeon. The subareolar location contains a rich lymphatic network and represents a potential site of injection for SLN identification.Methods: Between August 1, 1999, and December 31, 2000, we performed 159 SLN biopsy procedures on 158 patients with breast cancer. For each patient,99mTc-labeled sulfur colloid was injected into the subareolar location, and 1% isosulfan blue dye was given as an intraparenchymal injection.Results: In every case, at least one radioactive SLN was identified with the subareolar injection of technetium; a blue SLN was found in 97% of the cases. The blue SLN was also radioactive in 98% of the cases, indicating that the blue dye injected around the tumor and the technetium injected into the subareolar location drained to the same SLN.Conclusions: Subareolar injection of technetium can improve SLN identification rates for breast cancer. The simplicity and accuracy of this technique may also reduce the variable results reported with the standard intraparenchymal method.

The effects of mammographic detection and comorbidity on the survival of older women with breast cancer

OBJECTIVES: To determine an upper age limit or quantifiable level of comorbidity that would render mammography screening ineffectual in decreasing mortality in women aged 65 and older.

Survival of women ages 40‐49 years with breast carcinoma according to method of detection

The value of mammographic screening in reducing breast carcinoma mortality among women younger than 50 years continues to be controversial. Previous randomized clinical trials have not been definitive because of inadequate sample sizes, prolonged screening intervals, questionable randomization, and/or cross‐contamination between intervention groups. This study uses a historical prospective cohort design to examine differences in prognostic factors at the time of breast carcinoma diagnosis and differences in overall survival among patients ages 40‐49 years, according to the method of breast carcinoma detection.

Quality of life after postmastectomy breast reconstruction

PURPOSE/OBJECTIVES To explore womens expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN Qualitative focus group study. SETTING Integrated healthcare system in a midwestern suburban community. SAMPLE 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma

Surgical recommendation for early‐stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early‐stage breast carcinoma who underwent SLND without concomitant ALND.

Physical Activity in Women Receiving Chemotherapy for Breast Cancer: Adherence to a Walking Intervention

PURPOSE/OBJECTIVES To describe and predict adherence to a physical activity protocol for patients with breast cancer receiving chemotherapy. DESIGN Longitudinal, observational study. SETTING Cancer center in the upper Midwestern region of the United States. SAMPLE 36 patients with breast cancer aged 40-55 years who were receiving adjuvant treatment. METHODS A longitudinal study was conducted within a randomized clinical trial comparing the effects of physical activity versus bisphosphonates on bone mineral density. Participants randomized to physical activity were advised to walk 10,000 steps per day and received initial physical therapy consultation and ongoing motivational interviewing. Multilevel modeling was used to identify variables that predict adherence. MAIN RESEARCH VARIABLES Adherence to the 10,000-step protocol was estimated with total steps and mean steps per day. FINDINGS Thirty-six women were enrolled in the physical activity group; 29 provided step data. The mean total steps per participant for the first six weeks was 280,571 (SD = 111,992), which is 67% of the prescribed steps. Excluding days when no steps were recorded, the mean steps per day for the initial six-week period was 7,363 (SD = 2,421), a 74% adherence rate. A significant linear increase occurred in steps per day after chemotherapy in a treatment cycle (p < 0.0001). Baseline inactivity predicted adherence. CONCLUSIONS Adherence to the walking program was compromised during chemotherapy but improved after chemotherapy completion. IMPLICATIONS FOR NURSING Knowing that chemotherapy predicts adherence to a walking protocol is useful for selecting the type, timing, and intensity of physical activity interventions.

Recognition and Evaluation of Oncology-Related Symptoms in the Emergency Department☆☆☆★★★

STUDY OBJECTIVE To identify the oncology patient population presenting to the emergency department and examine the causes and clinical management of oncology symptoms in the ED. DESIGN Retrospective review of 5,640 adult patients, with the following variables identified for oncology patients presenting to the ED: age, sex, cancer type, cancer stage, previous cancer treatment, previous hospitalization, presenting symptoms, treatment provided in the ED, admission and discharge data, and day, time, and length of ED visit. SETTING Community teaching hospital with annual ED census of 31,000. PARTICIPANTS All adult oncology patients who presented to the ED during the study period. We identified these patients by cross-referencing ED logs and tumor registry records. RESULTS Cancer history was identified for 284 of the 5,640 adult ED admissions (5%). Forty-three percent (n = 122) of the 284 patients with cancer history had an oncology-related ED visit. The most common symptoms of these patients were gastrointestinal (48%), pain (40%), neurologic (38%), cardiac (25%), and pulmonary (23%). Ten percent of patients with oncology-related ED visits died during the admission, and 48% died within 1 year of the ED visit. CONCLUSION Oncology patients present to the ED with symptoms of undiagnosed malignancy, complications of cancer treatment, and acute disease-related symptoms. Knowledge of an individuals cancer history and ability to recognize oncologic symptoms are important to the management of oncology patients.

The notion of time in symptom experiences.

BackgroundThe experience of unpleasant sensations associated with the presence of symptoms prompts self-care or help seeking to obtain explanations for the symptoms, manage emotional responses, or obtain treatment for symptom alleviation and elimination. ObjectiveThe purpose of this article is to summarize and comment on three existing symptom theories, with special attention to temporal factors. MethodsExisting theories are synthesized as the time dimensions of symptom experiences and symptom management processes are elucidated. Clinical examples and findings from empirical studies illustrate critical points. DiscussionExisting theories describing the symptom experience and the process of symptom management refer implicitly to the role of time or use limited dimensions of time. Symptom experiences in time (SET) theory is proposed as a synthesis and extension of existing theories. The SET theory conceives the symptom experience as a flow process that explicitly incorporates temporal dimensions. Four dimensions of time are recognized: clock-calendar, biologic-social, perceived, and transcendent time. The four temporal dimensions are placed against a backdrop of “meaning-in-time” that brings forth the potential for transformation in a symptom experience. Increasing sophistication in design, measurement, and data analysis is required to test and evaluate SET theory-based propositions. ConclusionsThe SET theory extends previous work by incorporating multiple temporal dimensions that reflect the human experience of health and illness manifested in the expression and management of symptoms.

Breast and colorectal cancer survivors’ knowledge about their diagnosis and treatment

IntroductionAspects of a personal cancer history can have implications for future decisions regarding screening, diagnosis, and treatment. Clinicians must sometimes rely on patients’ self-report of their medical history. This study assessed knowledge of details of cancer diagnosis and treatment among breast and colorectal cancer survivors.MethodsWritten surveys were completed by 480 breast cancer survivors and 366 colorectal cancer survivors diagnosed between 1999 and 2008 at a large cancer center in the Minneapolis, MN, area (81% response rate). Responses were compared with cancer registry and medical records.ResultsForty percent of breast cancer survivors and 65% of colorectal cancer survivors were unable to identify their stage of disease. Seven percent of breast cancer survivors and 21% of colorectal cancer survivors in whom regional nodes were examined did not know whether they had positive nodes. Accuracy of knowledge of estrogen and progesterone status among breast cancer survivors was 58% and 39%, respectively. Of breast cancer survivors treated with doxorubicin, 43% correctly identified it as a drug they had received. Their accuracy of identification of receipt of tamoxifen or specific aromatase inhibitors was >90%. Of colorectal cancer survivors treated with oxaliplatin, 52% correctly identified it as a drug they had received. Accuracy on many items decreased with patient age.ConclusionsThis study identifies several gaps in adult cancer survivors’ knowledge of details of their diagnosis and treatment that have implications for follow-up care.Implications for cancer survivorsProvision of written treatment summaries to cancer survivors could help them obtain appropriate patient-centered long-term follow-up care.