Background In Mexico breast cancer is the leading cause of cancer mortality in women. The goal of reconstruction is restoration of patient's quality of life after cancer, including concerns about body image, sexuality, self-esteem and social life. Reconstruction is one of the most important determinants of long-term health. Autologous reconstruction has been found to offer a better satisfaction in the long term, even these findings, a paradigm shift toward implant reconstruction has been described previously. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together. It takes into account the best clinical evidence available, as well as the patient's values and preferences. In medical treatments where several options have been found, SDM has been a useful tool, increasing patient's satisfaction and better outcomes. Through this process of informing and involving the patient, high-quality decisions that align with patient preferences are achievable. Methods Evaluation of particular case was made, with personalized approach depending on breast cancer stage and mastectomy type planned. On first consultation basic information about different techniques was offered: pros and cons on surgical time, recovery time, long term complications, sensation and physical appearence. We offered a second consultation if the patient wanted to go deeper in the information we presented, or even is she wanted to look out for more information on the internet and other sources. When an abdominal free flap was planned, we saw the patient in a second consultation to review the CT-angio, and to establish the definitive flap option. For risk estimation we used www.brascore.org website, and talk about it with the patient. Then patient and plastic surgeon made decision on breast reconstruction technique. BREAST-Q questionnaries were applied in pre and postoperative setting. Results From 06/2014 to 06/2016 we performed 150 breast reconstructions with this SDM approach with the following techniques: 64% expander, 15% direct to implant, 11% DIEP flap, 6% lattisimus dorsi flap, 3% Becker implant, 1% TRAM flap. BREAST-Q questionnaries showed 100% think breast reconstruction is better than do not reconstruct, and 100% would recommend reconstructive surgery. 91.7% felt included in the decision process. Satisfaction with breast (preoperative vs postoperative) 66.21 vs 81.13, Satisfaction with outcome 85.06, Psychosocial well being 80.75 vs 88.35, Physical well-being 74.92 vs 68.73, Sexual well-being 66.66 vs 72.84, Satisfaction with information 86.86, Satisfaction with surgeon 98.73, Satisfaction with medical staff 96.2. Analysis Implant based reconstruction (82%) was prefered due to: simplicity, less overall risk, and giving more importance to cancer treatment and leaving reconstruction in second place. It could also be a short-term vision regarding benefits, in spite of shared information. Aesthetic improvement of the abdominal area seems to be a factor to decide for autologous abdominal flap among young adult women (7%). Possibility of pregnancy should be considered among young women. In our breast reconstruction program for young women with breast cancer, egg preservation is offered, so abdominal flaps should be delayed after a possible pregnancy. Conclusions We need to encourage SDM in breast reconstruction. We need information systems available to patients prior to breast reconstruction like educational meetings, giving healthcare professionals feedback, giving healthcare professionals learning materials, and using patient decision aids. Shared decisions leads to better outcomes and high patient's satisfaction in breast reconstruction. Citation Format: Maciel-Miranda A, Gutierrez-Zacarias LM, Cabrera-Galeana PA, Bargallo-Rocha E. Shared decision-making approach in breast reconstruction in a developing country [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-10.
Background: As survival increases in patients with breast cancer (BC), long-term care is required. Studies have shown that the psychosocial situation of this patients changes according to age and the types of treatment they received. Quality of life (QoL), unmet needs (UN), and social support (SS) have been significantly related to the way they live their survivorship. However, it is still unclear how these variables are affected by adjuvant endocrine therapy (AET) in Mexican patients with BC, to address and provide appropriate interventions. Objective: To describe the level of quality of life, unmet needs and social support, and to evaluate their relationship with the type of AET. Method: 200 patients with BC under AET were enrolled in a cross-sectional and correlational design. We administered QoL (EORTC-30 and BR-23), UN (SCNS-SF32), SS (MOS-SSS14), validated and standardized instruments in Mexican population. Premenopausal patients with ovarian function suppression were excluded. Non-parametric analyzes of U Mann Whitney and Spearman's correlation were used. Results: Mean age of the 186 patients evaluated was 54.52 (SD=10.65) years. Most of patients had elementary school (32.8%), were married (49.5%), housewives (60.2%), and catholics (86%). 54.8% underwent tamoxifen, 25.8% exemestane, 12.9% letrozol, 6.5% anastrozol. Mean time of AET were 2.59 years and 3.53 years since diagnosis. They reported a good level of global QoL (mean= 80 points, 0-100); however, they experienced insomnia (25.44 points), financial difficulties (24.19), fatigue (23.77), constipation (21.68) and pain (18.54); besides, adequate body image perception (91.6 points). The most UN were on information and the health system 31.13 (0-100 score), sexual (29.23) and psychological (28.21). The most frequent SS type was affection (88.46 points) and emotional-informational (79.56 points). Patients under anastrozole in comparison with exemestane, tamoxifen and letrozol reported significantly more nausea-vomiting (p=0.028; p=0.041; p=0.002 respectively), insomnia (p=0.008; p=.014; p=0.032, respectively), and appetite loss (p=0.049; p=0.049; p=0.04, respectively). We found that patients with anastrozol perceived significantly less SS than other types of AET (p=<0.005). It highlights that patients who received letrozol perceived significantly better future perspective (QoL). Our data also shows that the higher QoL level and the fewer reported symptoms the lower the UN. Conclusions: These results are consistent with previous studies in terms of information and psychological UN, and its relationship with QoL. Despite the small percent of patients treated with anastrozole in our study, they had more side effects than other aromatase inhibitors. In addition, it shows that postmenopausal survivors patients with BC still have sexual UN. This study is the first on Mexico exploring differences in perception of QoL, UN and SS according AET type. We concluded that the health care professionals who attend postmenopausal survivors patients with BC in the real clinical practice, should be aware of that long-term intervention includes care to sexual and psychological UN in the same importance as to the adverse events of treatment. Citation Format: Gálvez-Hernández L, Páez-Gerardo I, Ramírez-Medina R, Neri-Flores V, Bargallo-Rocha E, Villarreal-Garza C, Esparza N, Flores-Díaz D, Mohar A, Cabrera-Galeana P. Quality of life, unmet needs and social support of patients with breast cancer during adjuvant endocrine therapy in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-15.
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