Perception of cancer recurrence risk: More information is better

Objective

Breast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk.

Methods

A survey was conducted on women with a prior breast cancer (n = 141).

Results

Approximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence.

Conclusions

Perceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk.

Practice implications

Consistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.     

Improving Trauma Care in India: the Potential Role of the Rural Trauma Team Development Course (RTTDC)

The Rural Trauma Team Development Course (RTTDC) was devised to optimize trauma resuscitation training in under-resourced rural institutions. This program appears ideal for India because of its dense traffic, large population, and high frequency of rural trauma. We report on the feasibility and desirability of introducing RTTDC in India. An instructor course for 20 faculties and a provider course for 23 were conducted in New Delhi, India. The courses were evaluated by multiple choice question (MCQ) performance, by rating the modules on a three-point scale (1 = very relevant, 2 = relevant, and 3 = not relevant) for communication skills, principles of performance improvement and patient safety (PIPS), and clinical scenarios. Evaluation questionnaires including desirability of promulgation in India were completed using a five-point Likert Scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, and 5 = strongly disagree). Overall written comments were also provided. Both faculty and providers improved post-course MCQ scores (p?<?0.05) with lower scores in the provider group. Seventy-eight percent faculty and 74 % providers rated the communication module very relevant. PIPS was rated very relevant by 72 % faculty and 65 % providers. There were over 150 comments, generally positive with over 90 % of both faculty and providers rating strongly agree to agree that the course be promulgated widely in India. The RTTDC including plans for promulgation was enthusiastically received in India, and its potential for improving trauma care including communication skills and PIPS appears excellent.     

Stent thrombosis with drug-eluting stents: a re-examination of the evidence.

The excitement of drug-eluting stents and their promise for reduced restenosis rates have been tempered by recent reports of stent thrombosis. The mechanism of stent thrombosis is multifactorial but appears to be related to delayed endothelialization and healing, late stent malapposition, and antiplatelet resistance. The most important risk factor appears to be the discontinuation of dual antiplatelet therapy. The data from clinical trials suggest that drug-eluting stents are associated with increased incidence of death or myocardial infarction compared with bare metal stents at long-term follow-up, suggesting that the window of thrombotic risk with drug-eluting stents may extend far beyond that for bare metal stents. Measures to possibly decrease the incidence of stent thrombosis include improvements in antiplatelet regimens and newer generation of drug-eluting stents which have biodegradable polymers or are polymer-free. In addition, percutaneous coronary intervention with bare metal stents in patients may be helpful in those known to be intolerant or noncompliant to antiplatelet therapy, have planned procedures or surgeries, or have overwhelming risks which may require discontinuation of dual antiplatelet therapy.     

Interaction between G-protein beta and gamma subunit types is selective.

Signal-transducing guanine nucleotide-binding proteins (G proteins) are made up of three subunits, alpha, beta, and gamma. Each of these subunits comprises a family of proteins. The rules for association between members of one family with members of another to form a multimer are not known; it is not clear whether associations are specific or nonspecific. Other than transducin (Gt), the G protein in rod photoreceptors, most purified G proteins contain more than one subtype of beta or gamma subunits. The Gt alpha subunit is associated only with beta 1 and gamma 1. It is not known whether this specificity is due to the differential expression of these subunit types in a cell type or due to intrinsically different affinities between different beta and gamma subunit types. We have used a transfected cell assay system to examine the association of the beta 1, beta 2, and beta 3 proteins with the gamma 1 and gamma 2 proteins. Results show that gamma 1 does not associate with beta 2 and that beta 3 does not associate with gamma 1 or gamma 2. Differences in affinities between types of G protein subunits will impose restrictions on the formation of certain heterotrimers and determine which G protein will be active in a cell. A chimeric molecule of beta 1 and beta 2 was used to broadly map the regions on these subunits that determine specificity of association.     

Upper gastrointestinal haemorrhage in the elderly: a record of 92 patients in a joint geriatric/surgical unit

Ninety-two consecutive elderly patients suffering from acute gastrointestinal bleeding were studied over a 3-year period. All were admitted to a specially designated Geriatric/Surgical Ward under the care of consultant physicians in geriatric medicine. The nurses were trained to look after acute surgical and geriatric patients. Patients were aged between 65 and 93 years. All were managed jointly by the surgeons and physicians. Only 13 needed emergency surgery which was preceded by urgent endoscopy. The rest were managed conservatively with intravenous cimetidine and blood transfusions as required. The overall mortality was low at 5.4%. It is concluded that in a series of elderly patients with acute gastrointestinal bleeding the mortality was not high in a unit where the management was conservative and there was joint care between geriatricians and surgeons.     

Hemostatic gene polymorphisms and the prevalence of thrombotic complications in polycythemia vera and essential thrombocythemia.

Patients with polycythemia vera and essential thrombocythemia are at risk for thrombotic and bleeding complications. Currently, no diagnostic test can predict thrombohemorrhagic complications. In a prospective study of 86 patients with polycythemia vera (43 patients) or essential thrombocythemia (43 patients), we examined the possible role of polymorphisms of platelet adhesion receptors [glycoprotein (GP) Ibalpha, GPIa, GPIIIa) and clotting factor II (prothrombin's G20210A mutation) and clotting factor V (Leiden mutation) in determining the risk of thrombotic or bleeding complications. Except for an association between vasomotor symptoms and prothrombin mutation (P < 0.001), no significant correlation between polymorphism of clotting factors and thrombohemorrhagic complications was identified. When the entire patient cohort was considered, the polymorphisms of platelet adhesion receptors were not associated with the risk for thrombotic or bleeding complications. However, among patients with polycythemia vera, the presence of the PlA2 allele of GPIIIa was associated with an increased risk of arterial thrombosis. In view of previous studies linking the presence of the PlA2 allele of GPIIIa to a higher risk for coronary artery thrombosis, our data have physiologic relevance. However, they need to be confirmed in a larger study.