Decision aids for patients have recently been introduced in health care. A literature review was conducted to address the following research questions: 1) which types of decision aids have been ...developed?; 2) to what extent are they feasible, and acceptable to patients and health care providers?; 3) do decision aids affect the decision-making process and patients' outcomes? Thirty non-controlled (e.g., one-group-only designs) and controlled studies (e.g., randomized experimental designs) were identified. Decision aids were found to be feasible and acceptable to patients and to increase the agreement between patients' values and decisions and patients' knowledge. The effects of decision aids on decisions and on patients' outcomes, including decision uncertainty, satisfaction, and health, have rarely been addressed. When studied, the beneficial effects of decision aids on these outcomes appear to be rather modest. Implications for future development of decision aids and the design of studies are discussed. Key words: shared decision making; patient decision aids. (Med Decis Making 2000;20:112-127)
To evaluate the efficacy of radiotherapy without surgery, treatment results in patients treated for locally advanced breast cancer (n = 209) and those selected by positive axillary apex biopsy (n = ...289) in the period between 1977 and 1985 have been analysed retrospectively. Treatment consisted of primary irradiation to the breast and regional lymph nodes followed by a boost to the primary breast tumour and palpable regional disease to a mean normalised total dose (NTD) of 64.7 Gy with a range of 33.4-93 Gy (2 Gy fractions, alpha/beta = 5 Gy). Adjuvant systemic treatment was given in 30% of the locally advanced and in 40% of the apex positive patients. Thirty percent of the apex positive patients had an excisional biopsy of the breast tumour. By multivariate analysis a prognostic index is constructed for locoregional control, overall survival and distant disease-free interval. Primary tumour size and clinical nodal status are independent prognostic factors for locoregional control. Based on the prognostic index for local control four different groups can be identified with 5 year local control rates varying from 47 to 86%. Patients treated with adjuvant chemotherapy and patients irradiated to a NTD of 60 Gy or more had significantly better local control. For overall survival primary tumour size, clinical nodal size and age are independent prognostic factors. Patients irradiated to a NTD above 60 Gy had significantly better results. Survival according to the prognostic index for survival varies between 20 and 50% at 5 years for the four groups subdivided according to the index for survival. Primary tumour size, clinical node size and age are independent prognostic factors for distant disease-free interval. Patients treated with adjuvant hormonal therapy had significantly better results. In the four groups subdivided according to the prognostic index for distant disease-free interval results vary from 17 to 30% at 5 years.
To describe the percentage of local recurrences within 5 years after surgery for breast cancer as a performance indicator for Dutch hospitals.
Descriptive, cohort study.
All women diagnosed with a ...primary invasive breast cancer in 2003 for which they underwent curatively intended surgical treatment (with or without radiotherapy), were selected from the Netherlands Cancer Registry (NCR). NCR registration clerks collected additional information on recurrences within 5 years after initial diagnosis following standardized protocol. Percentages of local recurrences per hospital were estimated using Kaplan Meier analysis and were presented in forest plots and funnel plots.
In 2003, 9898 women diagnosed with primary breast cancer were curatively treated in one of the 99 Dutch hospitals. 266 patients experienced local recurrences within 5 years. The 5-year percentage of local recurrences was 3.03% (95% CI: 2.69-3.41). Following breast conserving surgery the 5-year percentage of local recurrence was 2.63% (95% CI: 2.21-3.12), and following mastectomy 3.50% (95% CI: 2.97-4.13). Stratification by hospital shows large variation in recurrence rates (0-17%). However, the number of patients treated in most hospitals is too small to provide reliable estimates.
The percentage of local recurrences following surgical treatment for breast cancer in the Netherlands was lower than the accepted standard of 5% within 5 years. Statements on differences in quality of care between hospitals cannot be made on the basis of these data, on account of the low average recurrence rate and the small number of cases per hospital.
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