BACKGROUNDHealth care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences in the treatment decision‐making process of older breast carcinoma patients and the differential impact on treatment received.METHODSA cross‐sectional survey was conducted of a population‐based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African‐American (n = 66), and white (n = 92) women age ≥ 55 years (total n = 257) and who were between 3–9 months after their primary breast carcinoma diagnosis.RESULTSApproximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African‐Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician–patient communication, social support, and health variables. Compared with African‐American and white women, Latina women were more likely to identify a family member as the final treatment decision‐maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43–26.20, for less acculturated Latinas; and AOR of 4.48; 95% CI, 1.09–18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast‐conserving surgery (BCS) when the family made the final treatment decision (AOR of 0.39; 95% CI, 0.18–0.85).CONCLUSIONSFamily appears to play a powerful role in treatment decision‐making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision‐making, rather than merely as translators and providers of social support. Cancer 2006. © 2006 American Cancer Society.

BACKGROUNDLittle is known about how disparities in the treatment of patients with breast carcinoma based on patient age and ethnicity are effected or mitigated at the patient‐physician interaction level. The objectives of this study were to document physician provision of informational support to patients at the time of a new diagnosis of breast carcinoma and to assess differences according to patient age and ethnic group in terms of the information received and desired.METHODSParticipants were 222 patients with breast carcinoma in Los Angeles County, California, age ≥ 55 years who were interviewed within 6 months of their diagnosis of breast carcinoma and/or within 1 month posttreatment. Respondents were asked about receipt and helpfulness of 10 tangible informational support items (e.g., whether booklets, videotapes, medical records, etc. were provided by physicians) and 15 interactive informational support items (e.g., whether physicians discussed breast cancer topics, such as risk of recurrence or treatment options). An index of the tangible informational support items and a scale of the interactive informational support items received were created for summary analyses. Patients' medical records were abstracted for breast carcinoma stage and treatment type; surgeons also were surveyed about sociodemographic and practice characteristics.RESULTSIn multiple linear regression analyses, older age (β coefficient [β] ± standard error [SE], − 0.08 ± 0.02; P = 0.001) and Latina ethnicity (β ± SE, − 1.21 ± 0.40; P = 0.003) had a negative association with physician provision of interactive informational support, controlling for patient and physician sociodemographic characteristics, practice characteristics, breast carcinoma stage, comorbidity, number of physicians seen, visit length, social support, and patient self‐efficacy in interacting with physicians (adjusted correlation coefficient [R2] for the model, 0.33; P < 0.00001). Both older patients and ethnic minority patients, as well as their respective comparison groups, rated most breast cancer information as at least as helpful. Both groups preferred interpersonal sources of information to written sources, although they received interpersonal sources less frequently.CONCLUSIONSOlder patients and Latina patients with breast carcinoma received less interactive informational support from their physicians compared with younger patients, differences that persisted after controlling for a wide range of sociodemographic, psychosocial, and physician factors. Improving the quality of communication at the patient‐physician interaction level may be an important avenue to reducing age and ethnic group treatment disparities among patients with breast carcinoma. Cancer 2003;97:1517–27. © 2003 American Cancer Society.DOI 10.1002/cncr.11211

Background and study aims: Buried bumper syndrome (BBS) may complicate percutaneous endoscopic gastrostomy placement. In these patients, endoscopic treatment ought to be considered. Various approaches have been published, ranging from dissectionbased techniques to novel dedicated devices, although the evidence supporting the use of the Balloon Dilation Pull (BDP) technique has been limited to single case reports. The aim of this paper is to assess the feasibility, efficacy and safety of the systematic use of the BDPtechnique for the endoscopic treatment of BBS. Patients and methods: We performed a retrospective multicenter analysis of prospectively collected data from all patients treated with the BDP-technique between January 2011 and November 2021. Results: In total, 26 patients were identified (median age 72 (SD ± 13) years, 74% male, 84.6% underlying neurological disease). Technical success was achieved in 92.3%, with a median procedure time of 17.5 minutes (range 5-27). Adverse events were identified in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade: moderate). Conclusions: Our experience suggests that the BDP-technique is highly efficacious and safe, using accessories readily available in every endoscopic unit. Given the limited procedure time and tools required, this procedure has the potential to further optimize patient care in the context of BBS.

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