Purpose
To assess and explain variation in quality of care in breast cancer patients and estimate its impact on disease outcome.
Methods
The Slovenian National Cancer Registry database and clinical ...records of 1053 women with unilateral primarily non-metastatic invasive breast cancer diagnosed in 2013 were reviewed in this retrospective analysis. Quality care was defined as care fully compliant with quality indicators (QI) defined by European Society of Breast Cancer Specialists (EUSOMA). Multivariate logistic regression was used to determine the predictors of receiving quality care. Differences in overall survival (OS) and event-free survival (EFS, relapse, or progression of disease or death considered an event) based on adherence to QI were analyzed using Kaplan–Meier method and Cox models.
Results
Younger age, no comorbidities, and HER2-negative tumor were associated with increased odds ratios for receiving quality care, whereas tumor stage and type of hospital had no significant association. Median follow-up was 54.5 months. Not receiving quality care resulted in an increased risk of dying hazard ratio (HR) 1.68; 95% confidence interval (CI) 1.06–2.66;
p
= 0.026. Difference in EFS between two groups was significant after adjusting for case mix and type of hospital (HR 1.80; 95% CI 1.29–2.52;
p
= 0.001) but disappeared when type of treatment was added into the model (HR 1.30; 95% CI 0.89–1.90;
p
= 0.178).
Conclusion
Observed comorbidity and age bias in delivering quality breast cancer care could be medically justifiable, whereas observed deviations dependent on HER2 status are puzzling. Complete adherence of treatment to quality indicators resulted in better OS.
Breast cancer in young women is a complex disease to manage due to its biological heterogeneity and special issues related to toxicity of different treatment strategies. Defining a cut-off for young ...age has been challenging since it is not clear whether the prognostic effect of age is continuously variable or whether there are certain thresholds at which the prognosis changes (e.g. those < 50 years of age or ≤ 35 years of age). In this review article, we define young patients as those being premenopausal. In addition, we discuss the most recent data of the biological diversity of breast cancer arising in premenopausal patients and current treatment modalities in early and advanced settings. Survivorship, with special emphasis on the importance of early supportive care, is also discussed.
The development of novel treatment methods is crucial for managing refractory ventricular tachycardia resistant to conventional therapies. Stereotactic arrhythmia radiotherapy holds promising ...potential for such patients, enabling precise non-invasive ablation of arrhythmogenic substrate with minimal damage to surrounding organs. This approach could be invaluable for patients in whom the target tissue is inaccessible through catheter ablation, frequent implantable cardioverter-defibrillator shocks significantly diminish their quality of life, or for those contraindicated for such treatment options due to poor health status. The target for irradiation is precisely defined through prior imaging diagnostics, ECGs of ventricular tachycardias and invasive or non-invasive electrophysiological mapping of the heart. After radiation treatment planning, irradiation of a single high dose of 25 Gy follows, which is generally well tolerated by the patients. Previous studies have reported good treatment efficacy, with a significant reduction in ventricular tachycardia episode frequency, while causing minimal side effects. We report on the first group of four patients with high-risk refractory ventricular tachycardia treated with stereotactic arrhythmia radiotherapy at the Institute of Oncology Ljubljana. This opens new possibilities for the treatment of this vulnerable patient group within the Slovenian healthcare system and contributes to the evolving field of radiotherapeutic treatment.
Oligometastatic disease (OMD) is a stage between locally advanced disease and polymetastatic disease, a group of diseases that are used interchangeably based on treatment history, ongoing treatment ...status, and imaging findings. The diagnosis of OMD is based on imaging because, as of yet, we are not aware of any specific biomarkers that would enable us to recognize patients with a low disease burden. In recent years, there has been an increasing interest in optimizing the treatment of OMD, owing mostly to the promising outcomes of combining local and systemic treatment. For the first time, the prospect of achieving long-term cures or possibly curing these individuals was established using this form of treatment. The standard name of OMD subgroups allows for the comparison of diverse circumstances in everyday clinical work, as well as the classification for clinical study comparability.
Za delno obsevanje dojke se v zadnjem desetletju povečuje zanimanje in je predmet številnih raziskav. V primerjavi s standardnim obsevanjem, ki lahko traja 5–7 tednov, je njegova prednost predvsem v ...krajšem zdravljenju, ki traja le 1–3 tedne. Kot že ime pove, se po operaciji obseva le manjši del dojke in sicer področje ležišča tumorja z varnostnim robom. Zaenkrat se na takšen način zdravi bolnice le znotraj nadzorovanih kliničnih raziskav, izven tega pa le kot možnost dopolnilnega obsevalnega zdravljenja za skrbno izbrano skupino bolnic.
Izhodišča: Optimizacija rehabilitacije onkoloških bolnikov in njihova vrnitev na delo je pomembna tako za izboljšanje počutja te ranljive skupine kot tudi za zmanjšanje družbenih in finančnih vplivov ...na celotno družbo. Osebe, ki so prebolele raka, se skušajo po zdravljenju vrniti na delo in poskušajo ponovno vzpostaviti nekdanjo strukturo vsakdanjega življenja. Z raziskavo smo želeli raziskati stališča onkologov do bolniške odsotnosti bolnic z rakom dojk. Metode: Izvedli smo manjšo anonimno spletno anketo o stališčih do bolniške odsotnosti med slovenskimi onkologi, ki se sodelujejo pri zdravljenu bolnic z rakom dojk. Rezultati: Na spletno anketo je od 52 povabljenih onkologov odgovorilo 24 (46,2%), od tega 8 (33,3 %) specialistov internistične onkologije, 9 (37,5 %) specialistov onkologije z radioterapijo in 7 (29,2 %) specialistov kirurgov. Stališče onkologov, ocenjeno z 10-stopenjsko Likertovo lestvico, je, da je pogovor z bolnico in obravnava vprašanj o vrnitvi na delovno mesto zelo pomemben del celostne obravnave (povprečna ocena 8,4/10). Hkrati pa ocenjujejo, da je razmerje med časom, ki ga imajo vsakodnevno na voljo za obravnavo bolnic z rakom dojk in časom, ki ga lahko posvetijo vprašanjem o bolniški odsotnosti med ali po zaključenem zdravljenju, slabo (povprečna ocena 3,6/10). Sorazmerno pogosto se srečujejo s t.i. »pritiski« bolnic v zvezi s podajanjem mnenj v zvezi z bolniško odsotnostjo ali invalidsko upokojitvijo (povprečna ocena 6,5/10). V okviru vprašalnika so bili zbrani tudi predlogi za dolžino bolniškega staleža upoštevajoč vrsto in zahtevnost zdravljenja ter individualne dejavnike. Predlagana je bila skupina strokovnjakov, ki bi sestavljala multidisciplinaren tim za obravnavo bolnic z bolniškim staležem. Zaključki: Pri obravnavi onkoloških bolnikov in presoji vrnitve na delo je nujen individualno prilagojen multidisciplinarni pristop. V pričujoči raziskavi so zbrana stališča onkologov o obravnavi bolnic z rakom dojk, ki so v delovnem razmerju, ki so lahko podlaga za nadaljnje raziskovanje.
Bone metastases cause pain and impair quality of life, and they can lead to serious complications that require immediate treatment. Urgent surgical treatment followed by postoperative radiotherapy ...should be considered in bone metastases with an impending or existing pathologic fracture or spinal cord compression. Patients who are unable or unwilling to undergo surgery should be referred for urgent radiotherapy. Patients with painful bone metastases without an impending or existing pathologic fracture and no spinal cord compression, regardless of the size of the metastatic lesion, are treated pharmacologically first, complemented by palliative irradiation. In palliative radiation, low total doses are prescribed and delivered in a single fraction or in short fractionation regimens. Patients with insufficient pain relief or pain relapse after initial radiation can be safely reirradiated. We conducted a retrospective review of palliative bone irradiations between 2018 – 2021 at the Institute of Oncology Ljubjana. Annually, we treat 800 bone metastases and we are seeing a decline in the number of irradiations. The most common fractionation is 5 x 4 Gy, with only 10% of patients receiving single-dose treatment. Palliative irradiation for painful bone metastases is effective, inexpensive, and safe. It is critical to select patients who will benefit from radiation therapy and present them in a multidisciplinary team meeting. Radiation treatment can be made easier to use by simplifying the procedure for the patient and prescribing the dose in one fraction.
With improved survival outcomes of patients with cancer, cardiovascular diseases have become an important part of morbidity and mortality. In recent years, there has been much interest in the ...literature on the impact of radiotherapy on the late cardiac toxicity. Various cardiac dose-volume constraints have been reported in association with cardiovascular events and mortality, but without consistent constraint. Low-dose heart exposure in adjuvant breast cancer radiotherapy can lead to important cardiac events in decade or more after treatment. However, in radical lung cancer radiotherapy, high-dose heart exposure can lead to increased cardiovascular mortality in the first years after treatment. We can further influence the survival of patients with cancer after chest irradiation by lowering the absorbed dose to the heart, which is already made possible by better irradiation techniques and image-guided radiotherapy. Additional benefits can be gained by better understanding and considering the impact of radiation on individual cardiac structures, also in connection with other patients’ comorbidities, and by close cardiac follow-up of patients after chest radiation therapy.
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