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BackgroundThe use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. ObjectiveThe main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. MethodsA systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions’ features, outcome measures, and results. ResultsWe identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. ConclusionsOur results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.

Background: The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. Objective: The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. Methods: A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions’ features, outcome measures, and results. Results: We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. Conclusions: Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.

Background: Breast cancer remains the most common cancer and most common cause of cancer-related mortality among women worldwide [1]. While incidence rates have historically been higher in the developed world, there has been a recent sharp increase in incidence and mortality in the developing world [2]. Objectives: The main purpose of this study was to assess the barriers resulting in delayed patient presentation to breast cancer care among women receiving breast cancer drugs at Hawassa University Comprehensive Specialized Hospital. This study was the first conducted in Hawassa. Methods: A hospital-based descriptive cross-sectional study design was done from June 01, 2017 to December 30, 2017 to answer the study objectives. All delayed 106 women receiving breast cancer drug during data collection period participated in the study. Structured data collection tool which encompass possible barriers in developing countries were applied to collect data from each study subject. Before the data collection, written ethical clearance letter was obtained from IRB of Hawassa University. Data entry was done using EPI Info 3.5.4 and exported to SPSS version 20.0 software package for analysis. Results: This study revealed that delay is multifactorial. Of 106 delayed women to breast cancer care, 98.1% did not have knowledge about sign and symptom of breast cancer; about 71.7% of them were late thinking that the breast cancer lump was not dangerous enough to consult expert health professionals and 64.2% of mothers delayed using alternative medicines such as prayer, herbal remedy or traditional healers. There was no significant statistical association found with major causes of delay and sociodemographic characteristics of the women. Conclusion: A significant percentage of women with breast cancer in Hawassa and nearby were experiencing presentation delay due to sociocultural, economic and health and health-related causes. Hence, an intense and focused awareness campaign about breast cancer is needed to educate the general population by the Ethiopian Cancer Association, Federal Ministry of Health, Regional Health Offices and any other concerned body. Refereed/Peer-reviewed

Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation therapy. Results: Women in Ontario received more optimal care in communities well supplied by primary care physicians. They were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (rate ratio = 1.65) and communities lacking specialist physicians (rate ratio = 1.33). Canadian advantages were explained by better health insurance coverage and greater primary care access. Conclusions: Policy makers ought to ensure that the newly insured are adequately insured. The Medicaid program should be expanded, as intended, across all 50 states. Strengthening America’s system of primary care will probably be the best way to ensure that the Affordable Care Act’s full benefits are realized.

Purpose: There is a lack of real-world studies evaluating the impact on survival of an evidence-based pathway of care in breast cancer. The aim of this work is to investigate the effect of adherence to guidelines on long-term survival for a cohort of Italian breast cancer patients. Methods: The cohort included incident female breast cancer cases (2007–12), from the registry of the Milan province (Italy), not metastatic at diagnosis and receiving primary surgery. We selected sets of indicators, according to patient and tumor characteristics. We then defined the pathway of care as adherent to guidelines if it fulfilled at least 80% of the indicators. Indicators were measured using different administrative health databases linked on a unique key. A causal inference approach was used, drawing a directed acyclic graph and fitting an inverse probability weighted marginal structural model, accounting for patient’s demographic, socioeconomic and tumor characteristics. Results: The analysis included 6333 patients, 69% of them were classified as having an adherent care. Mean age was 61 years (standard deviation, 13.6 years) and half of the patients were in Stage I (50%) at diagnosis. Median follow-up time was 5.6 years. Overall, 5-year survival was 90% (95% CI, 89–91%). The estimated risk of death was 30% lower for patients with adherent than nonadherent care (hazard ratio [HR], 0.66; 95% CI, 0.55–0.77). Conclusions: Our study confirms, in real-world care, the impact on survival of receiving a care pathway adherent to guidelines in non-metastatic breast cancer patients.

Introduction: In recognition of the advances and evidence based changes in clinical practice that have occurred in recent years and taking into account the knowledge and experience accumulated through the voluntary breast unit certification programme, Eusoma has produced this up-dated and revised guidelines on the requirements of a Specialist Breast Centre (BC). Methods: The content of these guidelines is based on evidence from the recent relevant peer reviewed literature and the consensus of a multidisciplinary team of European experts. The guidelines define the requirements for each breast service and for the specialists who work in specialist Breast Centres. Results: The guidelines identify the minimum requirements needed to set up a BC, these being an integrated Breast Centre, dealing with a sufficient number of cases to allow effective working and continuing expertise, dedicated specialists working with a multidisciplinary approach, providing all services throughout the patients pathway and data collection and audit. It is essential that the BC also guarantees the continuity of care for patients with advanced (metastatic) disease offering treatments according to multidisciplinary competencies and a high quality palliative care service. The BC must ensure that comprehensive support and expertise may be needed, not only through the core BC team, but also ensure that all other medical and paramedical expertise that may be necessary depending on the individual case are freely available, referring the patient to the specific care provider depending on the problem. Conclusions: Applying minimum requirements and quality indicators is essential to improve organisation, performance and outcome in breast care. Efficacy and compliance have to be constantly monitored to evaluate the quality of patient care and to allow appropriate corrective actions leading to improvements in patient care. (C) 2013 Elsevier Ltd. All rights reserved.

Background: Key success factors for significantly improving patient satisfaction on breast cancer care are not well known. Data obtained over a period of 6 years in a breast cancer clinic provide a portrait of the evolution of patient satisfaction on quality of care. Methods: We measured 19 patient satisfaction items and 6 groups of 60 consecutive Primary Operable Breast Cancer patients filled in the (validated) questionnaire. A first group prior and a second group after the implementation of a clinical pathway, a third group after the introduction of a breast cancer nurse following patients systematically only postoperatively, a fourth group having an additional consultation of the breast nurse in the diagnostic and preoperative phase and a fifth and sixth group after implementing education sessions for hospital staff and the Eusoma and other national guidelines. Results: We found that the successive modifications of the care process resulted in an improvement of patient satisfaction for all items and for 16 of the 19 items these improvements were significant. The number of items for which dissatisfaction was higher than 5% diminished from 18 to 3 of the 19 items (group 6 versus group 1). Conclusion: Significant improvements were only achieved by combining the implementation of a clinical pathway, a specialist breast nurse, education sessions and Eusoma and national guidelines. In particular, the role of the specialist breast cancer nurse was found to be of major importance to coordinate the care process and guide patients through the pre- and postoperative phase of their treatment. ispartof: FEB Research Report KBI_1310 nrpages: 14 status: published

Objectives To explore attitudes of French surgeons and their patients towards treatment decision-making (TDM) in the medical encounter. Methods Surgeons involved in early stage breast cancer and their patients treated in a French cancer care network received a cross-sectional survey questionnaire containing examples of four different approaches to TDM: paternalistic, “some sharing”, informed TDM and, shared TDM. Results Surgeons’ interaction styles were clearly distributed among paternalistic, shared and mixed. The paternalistic approach seemed to be associated with private rather than public practice and with less professional experience. Patients reported a rather low level of participation in TDM, varying by socio-demographic characteristics. One third of patients were dissatisfied with the way their treatment decision had been made. Conclusion Most surgeons reported adopting the “some sharing” approach. However, one patient out of three reported that they would have liked to participate more in the TDM process. Practice implications Surgeons need to ask patients what their preferences for involvement in TDM are and then think about ways to accommodate both their own and patients’ preferences regarding the TDM process to be used in each encounter. In addition, decision aids could be offered to surgeons to help them discuss treatment options with their patients.

To define a set of quality indicators that should be routinely measured and evaluated to confirm that the clinical outcome reaches the requested standards, Eusoma has organised a workshop during which twenty four experts from different disciplines have reviewed the international literature and selected the main process and outcome indicators available for quality assurance of breast cancer care. A review of the literature for evidence-based recommendations have been performed by the steering committee. The experts have identified the quality indicators also taking into account the usability and feasibility. For each of them it has been reported: definition, minimum and target standard, motivation for selection and level of evidence (graded according to AHRO). In overall 17 main quality indicators have been identified, respectively, 7 on diagnosis, 4 on surgery and loco-regional treatment, 2 on systemic treatment and 4 on staging, counselling, follow-up and rehabilitation. Breast Units in Europe are invited to comply with these indicators and monitor them during their periodic audit meetings.

Italian population-based breast cancer screening programmes with 2-year, high-quality mammography started in the cities of Florence and Turin in the early 1990s. Breast cancer cases from the local Tumour Registry were classified by method of detection and tumour characteristics (size, nodal-status and grade). Follow-up was at December 2001. In total, 4444 breast cancer cases were analysed. The Hazard Ratio comparing before and after-invitation breast cancer cases indicated a 27% reduction (HR=0.73; 95%CI: 0.61-0.87) in the risk of dying for the disease. After adjustment for tumour characteristics, survival rate was comparable by invitation status, whereas the proportion of early cancer was 33.7% and 46.6% in the before and after-invitation group. Survival rates by tumour characteristic subgroups was comparable by invitation status. Late stage and grade 3 were indicators of poor prognosis. Adjustment for tumour characteristics confirmed screening and not differential treatment as the most important reason for the observed survival benefit. The survival analysis by specific subgroups did not support the hypothesis that the difference in prognosis was attributable to differential treatment.