Management of recurrent locoregional breast cancer: oncologist survey

Locoregional recurrence (LRR) after therapy for early breast cancer is common. A questionnaire was used to assess consensus between breast oncologists about the definition, prognosis and management of patients with LRR. The questionnaire was mailed to surgical, radiation and medical oncologists in Canada, the UK and the USA. Of 495 questionnaires, 322 (65%) were returned. Most clinicians sampled agree that disease in the skin of the chest wall, surgical scar, axilla, ipsilateral breast tumor recurrence (IBTR), infraclavicular lymph nodes, supraclavicular fossa lymph nodes and internal mammary lymph nodes constitute sites of LRR. The sites that were felt to be curable by the majority of respondents were: IBTR, surgical scar, axilla or chest wall. It was for these disease sites that local therapy was generally recommended. Irrespective of the site of recurrence, most respondents surveyed recommend initiation of a new systemic therapy at the time of LRR. While the results of this survey show general agreement regarding the definition of sites of LRR, treatment recommendations vary among oncologists. Due to the variation in sites of recurrence, time since initial diagnosis and prior therapy, the exact prognosis and optimal management of LRR remain undefined. In the absence of randomized prospective trial data, recommendations for local and systemic therapy of LRR will continue to mimic those offered at the time of initial presentation of breast cancer.     

The changing role of the surgical oncologist

It is increasingly important for the surgical oncologist and surgeons to have a thorough understanding of the advantages and limitations of adjuvant systemic chemotherapy, hormonal therapy, and adjuvant radiotherapy in various resectable cancers. Justification for the field of surgical oncology should include the fact that enough knowledge has been acquired about these adjunctive treatments for patients with cancer that they can be integrated into overall management. Too often in the recent past, surgeons, after the technical surgical resection, turned over the entire management of patients to the medical oncologist or the radiotherapist. Comprehensive management for surgeons and surgical oncologists should maintain their voice in management policy so that the patients can be served best by the application of adjuvant treatment or by the avoidance of adjuvant treatment, systemic or local, when it is not appropriate or significantly helpful. The overall justification for the field of surgical oncology is that the surgeon not only knows how to use medical treatments in advanced cancers, but also knows how to select minimal surgical procedures in early cancers and how to manage and direct the application of adjuvant treatments, regionally and systemically.     

The case for specialist units

There is considerable evidence that management in a specialist unit is beneficial both for the individual patient and for the economy. A specialised unit provides a focus for a campaign for prevention, for the improvement in care in areas such as orthopaedic, bladder, bowel, skin, etc and for the promotion of interdisciplinary work, combining the needs of public health, low-cost technology, and high quality. Strategy and training is dictated by the specific problems that occur in patients with spinal injuries, particularly the multisystem impairment, which is a feature of such injuries and can only be comprehensively dealt with in a specialised unit. For developing countries, training may be either on-site or in centres abroad, or a combination of both, and rather than training on an individual basis, it is preferable for a team to be trained together. The likely cost depends on local circumstances. However, even the cost of a purpose-built centre of 44 beds serving 3000 paralysed people in the UK is only the equivalent of the lifetime costs of about 12 people with SCI.     

The surgical oncologist as a key translator of basic biology to patients with gastrointestinal cancer: Asking the right questions

Presented as the Lucy Wortham James Clinical Award Lecture at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

The colorectal cancer multidisciplinary team and the interlinked role of the clinical nurse specialist

In order to continue to treat patients with colorectal cancer it is an official requirement (Peer Review Standard) that all cases are managed by a designated multidisciplinary team (MDT) which must meet regularly, usually weekly, to discuss them. This team must have written policies, it must keep records, and it must download them annually into the National Bowel Cancer Database (NBOCAP). There must be clinical nurse specialist input. This article summarizes best practice in all of these areas.     

Robotic surgical training of the urologic oncologist

Robotic-assisted surgery has become an increasingly popular approach to the treatment of a variety of urologic malignancies. The use of minimally invasive techniques for treatment of genitourinary cancers has evolved from conventional laparoscopy to the use of robotic-assisted instrumentation. Many questions remain regarding the safest and most effective way to teach robotic surgery to trainees. Work hour restrictions, medical and legal concerns, and the unique operative set-up of the robotic system have made it increasingly difficult to provide “hands on” operative training to residents and fellows. We review the current literature regarding robotic surgical training, highlight potentially effective training strategies, and discuss future improvements in robotic surgical training of the urologic oncologist.     

应用Delphi法构建肠造口医院-社区-家庭护理模式

目的 针对肠造口患者构建一套系统化、规范化的医院-社区-家庭护理模式,为肠造口护理工作提供参考.方法 在文献回顾的基础上利用德尔菲法对33名专家进行两轮专家函询构建肠造口医院-社区-家庭护理模式.结果 两轮专家咨询后,有效问卷回收率分别为94.29%、100%;专家的权威系数为0.88;专家协调系数W分别为0.20、0.22.最终形成包括模式目的 、实施机构、组织结构、护士职责和工作内容5个部分22个条目的 肠造口医院-社区-家庭护理模式.结论 专家对肠造口医院-社区-家庭护理模式的积极性和代表性较好,结果可靠,可用于肠造口患者的护理.