Summary

Background

Breast care nurses (BCNs) are specialized caregivers in certified breast cancer center teams. The impact of a BCN's work remains unknown.

Patients and Methods

The role of BCN care was evaluated in a post-discharge mail survey of 360 patients.

Results

A total of 207 (87%) of 237 (66%) returned questionnaires were analyzed; 171 (83%) patients had BCN contact, 36 (17%) did not. The mean global quality of life scores (EORTC-QLQ-C30) were 66.3 for women with contact to a BCN versus 62.5 for women without such contact (p < 0.05). Women with a BCN contact had better results than women without (p < 0.001) for the following parameters: receipt of information material (84 vs. 64%), information about hospital procedures (93 vs. 72%) and treatment plan (91 vs. 63%), and knowledge of own tumor hormone receptor status (83 vs. 53%). Medication adherence correlated with the knowledge about the tumor hormone receptor status and was significantly higher in women having contact with a BCN (79 vs. 56%). The high recommendation rate (81%) reflects the high level of satisfaction with BCNs. A qualitative analysis of comments and suggestions identified aspects to improve BCN services.

Conclusions

BCN improve satisfaction and treatment adherence in breast cancer patients.

Summary

A decrease in medical practice variations in national breast cancer care has been shown to improve survival and the negative impact of the disease on affected women and their families. The following report describes the concert of efforts undertaken by the medical societies to optimize national breast cancer care by organizational centralization of multidisciplinary medical competence in certified breast centers (CBC), aiming to attain continual quality of health care by implementation of evidence-and consensus-based guidelines. Centralization and the systematic pursuit of organizational development by tracking guideline adherence using performance quality indicators over time demonstrate the feasibility and practicability of the implementation concept to bridge the gap between determined scientific best evidence and applied best practice. However, the proof of concept will remain pending until the data of the population-based cancer registries are analyzed for survival estimates.

Summary

Background

The Organgruppe Mamma of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) performed a nationwide 3-phase analysis of the structure of care and standard of therapy given to patients with breast cancer from 2002 (4th quarter) to 2004 (4th quarter). The extent to which national and international treatment recommendations are implemented in routine clinical practice had so far not been evaluated in an interdisciplinary approach. No reliable data on the pattern of care of these patients have been published in Germany before.

Patients and Methods

The project included early breast cancer in the adjuvant and neoadjuvant setting as well as metastatic disease. We present the results of phase III of the AGO analysis, which are based on a survey conducted by the Organkommission Mamma in the 4th quarter of 2004.

Results

Evaluation of the data reveals that treatment based on the guidelines is now being implemented very reliably in certain sectors. This is of particular relevance to the pattern of adjuvant treatment in early breast cancer. In contrast, in metastatic breast cancer (MBC), the complexity of the interdisciplinary treatment approach is complicating this kind of straightforward analysis.

Conclusion

The present analysis conducted by the AGO was the first attempt to analyse the treatment provided in patients presenting with MBC in a systematic fashion. The fundamental problem remains, irrespective of the stage of the tumour, that too few patients are treated in randomised clinical trials. The mission set by the AGO-Organkommission Mamma is the longitudinal observation of the therapy practices for breast cancer on the basis of the observations discussed here, which should ultimately benefit the optimisation of therapy quality in Germany.

Summary

For 2010, the annual incidence of breast cancer is estimated to increase from now 1.15 Mio to 1.5 Mio new cases per year. The increase is mainly seen in low and middle income countries. Resource limitations in means of finance, personnel, infrastructure, and by political instability are tremendous. Currently, little attention is paid to breast care in low-resource settings due to other health priorities. However, with increasing life expectancy and reduction of mortality due to infectious diseases, more people are confronted with non-communicable diseases, and the topic of cancer in developing countries will emerge more and more. Specific guidelines for breast cancer were given by the Global Breast Health Initiative differentiating according to available resources in different settings. From awareness in public and health care facilities to obtaining the diagnosis, deciding on strategies of treatment, and putting strategies into practice – all these obstacles differ substantially in developed and developing countries. Further research is essential to meet the challenge of breast cancer worldwide in the coming years.