Was passiert nach histologischer Diagnosesicherung?

Zusammenfassung. Nachdem die Diagnose Mammakarzinom histologisch gesichert wurde, folgt das Aufklärungsgespräch über den Befund mit der Patientin. Es bietet sich an, dass dieses durch einen Brustchirurgen, eine Brustchirurgin geführt wird. Beim Überbringen der schlechten Nachricht gilt es einige Regeln zu beachten. Als Unterstützung kann das NURSE-Modell dienen. Neben der Einteilung der Mammakarzinome in die verschiedenen histologischen Typen existiert seit 2011 die neuere Einteilung der 12. St. Gallen-Konferenz. Sie beruht auf der Erkennung der tumorbiologischen Untergruppen, den sogenannten intrinsischen Subtypen, und erleichtert es, Patientinnen zu identifizieren, die von einer Chemotherapie profitieren würden bzw. durch eine Chemotherapie übertherapiert wären. Für bestimme Patientinnen ist ausserdem die Aufklärung über eine mögliche genetische Beratung oder den Fertilitätserhalt eine wichtige Information. Das Mammakarzinom stellt sogar die häufigste Indikation zur Beratung hinsichtlich Fertilitätserhalt im Rahmen einer onkologischen Erkrankung dar. Im Weiteren sollte geklärt werden, ob präoperative Staginguntersuchungen erforderlich sind. Das gesamte Behandlungskonzept wird, sobald alle Befunde vorliegen, in einer präoperativen Tumorkonferenz festgelegt und es wird entschieden, ob eine Indikation für eine neoadjuvante Chemotherapie oder für eine primäre Operation vorliegt. Bei der multidisziplinären Behandlung von Brustkrebspatientinnen sind auch die Breast Care Nurse und die Psychoonkologie ein wichtiger Bestandteil, um die emotionalen, informationsbezogenen und physischen Bedürfnisse der Patientinnen abzudecken und die Krankheitsverarbeitung zu fördern, die Lebensqualität zu verbessern und die psychischen Belastungszeichen zu erkennen und zu behandeln.

Effectiveness of Breast Care Nurse Led Video Orientation Programme on Information and Navigation for Newly Diagnosed Breast Cancer Patients at University Malaya Medical Center, Malaysia

Background: Advancement in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, treatment complexities, patients' fears and poor coping skills at the time of diagnosis may affect patient´s decision that cause treatment delays and nonadherence. Main reasons for advance BC presentation in Malaysia are delay in taking treatment decision and poor breast health literacy on disease and treatment outcomes may contribute to nonadherence to treatments. To address this knowledge gap, a breast care nurse (BCN) led orientation video for new patients to navigate them through complex multimodal treatment processes. This audio-visual educational tool address multimodal treatments and its side effects and in addition navigating admission, discharge and follow-up, advice on diet and exercise to maintain a healthy life style during survivorship period was developed in layperson language in Malay, Mandarin and English. Aim: To assess the effectiveness of BCN led video orientation on the improvement of patient knowledge and satisfaction. Methods: A pilot study was carried out in 50 patients to assess the effectiveness of the video, and found that patients needed a face to face interaction to watch the video. Hence, a BCN led orientation was developed to use the video. A self-administered pre- and postsurvey on 246 newly diagnosed breast cancer patients in University Malaya Medical Center (UMMC) was performed to evaluate expectations, satisfactions and knowledge (a Likert scale response using items 4 number scale was used, 0 means “no knowledge” and 4 means “a great degree of knowledge”). The scoring was done before and after the video orientation was done. A Wilcoxon matched-paired signed-rank test was perform to analyze the changes in the scoring. Results: Among 247 patients, who received the BCN led video orientation program, 79.3% (n= 197) found that the video met or exceeded their expectations. 23.9% (n=59) and 56.3% (139) consecutively found the video very effective and effective in broadening their perspective on BC treatments. And 171 (69.2%) of them overall rated the video highly met their expectations. There were significant improvement in knowledge for treatment options for BC, mean scores (M=0.93 versus M=2.97) before and after watching the video ( P < 0.001). Similar findings were found in different types of operation for BC; procedure for admission in UMMC, information on chemotherapy; radiotherapy; hormone therapy and alternative medicine for BC. It also showed improved knowledge scores for healthy diet; physical activity after treatments and care of the arm after operation ( P < 0.001). Conclusion: Video-based information on treatments and navigating care through a BCN led service had effectively improved patients' knowledge and satisfaction. This approach can be used to educate cancer patients in a middle resource setting.

Driving Change: Do Nurse-Led Clinics Make a Difference for the Patient?

Background and context: The number of people living with breast cancer and beyond is increasing. The nurse led clinics prioritise the patient as the center of care, providing the opportunity to address the serious medical, functional and psychosocial consequences of cancer and its treatments. Aim: To evaluate a model of survivorship care from the patient´s perspective. Strategy/Tactics: Eligible patients were identified through the multidisciplinary team breast meeting. Consultation with the breast care nurse at approximately 10 months postdiagnosis. Prior to this appointment, validated screening tools were sent to attendees and completed. Through assessment and discussion, issues were identified and addressed, with onward referral to internal and community based organizations. Resource packs provided together with a care plan. Program/Policy process: Having offered the nurse led clinics for 18 months Western Health conducted a patient satisfaction survey. Data were collected in the form of a questionnaire to ascertain the effect of the clinic in providing optimal and supportive survivorship care. Outcomes: 208 patients seen, 134 were born in a country other than Australia. 208 surveys sent to both English and non-English speaking patients. 91 respondents. 72% made changes to their lifestyles and relationships following the nurse led clinic. 93% of respondents felt they had more time to talk about their concerns and ask questions. 92% felt the BCN provided helpful information about support services and programs that they would otherwise not be aware of. What was learned: Patients may experience significant burden of symptoms following definitive treatment of early breast cancer. The nurse led clinic allows patients space to reflect and explore their disease experience to date, which for many has resulted in positive lifestyle changes.

Treatment Information and Navigation Program for New Patients With Breast Cancer in Malaysia

Purpose Advancements in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, patient fears, and poor coping skills at the time of diagnosis may affect a patient’s decision, causing treatment delays and nonadherence. The main reasons for advanced BC presentation in Malaysia are a delay in making a treatment decision and poor breast health literacy on the disease and its treatment outcomes. To address this gap, we developed an audio-visual tool on multimodal treatments; adverse effects; navigating admission, discharge, and follow-up; and advice on diet and exercise to maintain a healthy lifestyle during the survivorship period in layperson language in Malay, Mandarin, and English. This study aims to assess its effectiveness in improving patient knowledge and satisfaction. Methods A pilot study of 50 patients found that patients needed face-to-face interaction to watch the video. Hence, a breast care nurse–led orientation was developed. A self-administered pre- and postsurvey in 246 patients with newly diagnosed breast cancer in University Malaya Medical Centre was performed to evaluate expectations, satisfactions, and knowledge. We scored the results with the following Likert scale terms: 0 means no knowledge and 4 means a great degree of knowledge. Scoring was done pre- and postintervention. A Wilcoxon matched paired signed rank test was used in the analysis. Results Among 246 patients who received the intervention, 79.3% (n = 197) found that the video met or exceeded their expectations, and 80.2% found the video effective in broadening their perspective on BC treatments. One hundred seventy-one patients (69.2%) rated the video as highly meeting their expectations. There were significant improvements in knowledge of treatment options for BC (mean scores 0.93 v 2.97 for pre- and postintervention; P < .001). Similar findings were found in different types of operations for BC; admission procedures; and information on chemotherapy, radiotherapy, hormone therapy, and alternative medicine. Knowledge scores for healthy diet, physical activity after treatment, and care of the arm were observed ( P < .001). Conclusion Video-based information on treatments and navigating care through a breast care nurse–led service effectively improved patients’ knowledge and satisfaction. This approach can be used to educate patients with cancer in a middle-resource setting. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.